Provider Demographics
NPI:1003652264
Name:PASTEN, LUIS FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:FERNANDO
Last Name:PASTEN
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 1:1752 FERNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1563
Mailing Address - Country:US
Mailing Address - Phone:619-493-9457
Mailing Address - Fax:
Practice Address - Street 1:BOULEVARD DE LAS BELLAS ARTES 19315, NUEVA TIJUANA
Practice Address - Street 2:BOULEVAD DE LAS BELLAS ARTES 19315, NUEVA TIJUANA
Practice Address - City:TIJUANA
Practice Address - State:MEXICO
Practice Address - Zip Code:22435
Practice Address - Country:MX
Practice Address - Phone:664-873-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ091812352086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty