Provider Demographics
NPI:1134487705
Name:PASTRANA, MARLON (MD)
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:
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 1:6241 SW 112TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1079
Mailing Address - Country:US
Mailing Address - Phone:786-304-8867
Mailing Address - Fax:
Practice Address - Street 1:6200 SW 72ND ST STE 502
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4830
Practice Address - Country:US
Practice Address - Phone:305-271-9777
Practice Address - Fax:786-533-9450
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD464939208600000X
FLME139634208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery