Provider Demographics
NPI:1023725538
Name:PASTRANA, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PASTRANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7478 NW 117TH LN
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4270
Mailing Address - Country:US
Mailing Address - Phone:516-543-7131
Mailing Address - Fax:
Practice Address - Street 1:7478 NW 117TH LN
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-4270
Practice Address - Country:US
Practice Address - Phone:516-543-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-224966106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician