Provider Demographics
NPI:1558454595
Name:PASCUAL, PRODE P (MD)
Entity Type:Individual
Prefix:DR
First Name:PRODE
Middle Name:P
Last Name:PASCUAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 LELAND CT E
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-7710
Mailing Address - Country:US
Mailing Address - Phone:562-508-7123
Mailing Address - Fax:
Practice Address - Street 1:13222 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3249
Practice Address - Country:US
Practice Address - Phone:562-508-7123
Practice Address - Fax:888-675-3950
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30986207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A309860Medicaid
CA00A309860Medicaid
CAA26303Medicare UPIN
CA000023627Medicare PIN