Provider Demographics
NPI:1619641826
Name:PASTOR, LUIS JR (PT)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:PASTOR
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-6121
Mailing Address - Country:US
Mailing Address - Phone:916-335-1421
Mailing Address - Fax:
Practice Address - Street 1:271 OBSERVATORY AVE
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5757
Practice Address - Country:US
Practice Address - Phone:707-463-7346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35551225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35551OtherPT LICENSE