Provider Demographics
NPI:1598810475
Name:PASTRANO, ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:PASTRANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8881 FLETCHER PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3132
Mailing Address - Country:US
Mailing Address - Phone:858-499-2600
Mailing Address - Fax:619-462-3064
Practice Address - Street 1:8881 FLETCHER PKWY STE 105
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3132
Practice Address - Country:US
Practice Address - Phone:858-499-2600
Practice Address - Fax:619-462-3064
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225698207Q00000X
CAA119784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine