Provider Demographics
NPI:1689314643
Name:PASTRANA, CESAR AUGUSTO JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CESAR
Middle Name:AUGUSTO
Last Name:PASTRANA
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3495 W 10TH AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5149
Mailing Address - Country:US
Mailing Address - Phone:954-310-6111
Mailing Address - Fax:
Practice Address - Street 1:1855 N CORPORATE LAKES BLVD STE 2
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3274
Practice Address - Country:US
Practice Address - Phone:754-837-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9115237363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant