Provider Demographics
NPI:1710243852
Name:PASTRANA, VICTOR MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:MANUEL
Last Name:PASTRANA
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 1:2001 W 68TH ST, SUITE 202, MEDICAL EDUCATION DEPT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016
Mailing Address - Country:US
Mailing Address - Phone:305-364-2107
Mailing Address - Fax:305-846-9711
Practice Address - Street 1:2001 W 68TH ST, SUITE 202, MEDICAL EDUCATION DEPT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-364-2107
Practice Address - Fax:305-846-9711
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2023-06-30
Deactivation Date:2020-04-16
Deactivation Code:
Reactivation Date:2020-05-06
Provider Licenses
StateLicense IDTaxonomies
FLME158714207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty