Provider Demographics
NPI:1598465627
Name:PASTRANA, DORA LIZ X
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:LIZ
Last Name:PASTRANA
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BJ 676 CALLE 51
Mailing Address - Street 2:JARDINES DE RIO GRANDE
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-688-4986
Mailing Address - Fax:
Practice Address - Street 1:CARR 845 INT. 199 KM. 3 HM 9 BARRIO LAS CUEVAS
Practice Address - Street 2:CENTRO RECUPERACION VIDA INDEPENDIENTE
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00926-0092
Practice Address - Country:US
Practice Address - Phone:939-277-0452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR30549164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse