Provider Demographics
NPI:1134716053
Name:PASTORIN, JUANARIO ALBERTO
Entity type:Individual
Prefix:MR
First Name:JUANARIO
Middle Name:ALBERTO
Last Name:PASTORIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11323 E ELENA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-7666
Mailing Address - Country:US
Mailing Address - Phone:480-274-9208
Mailing Address - Fax:
Practice Address - Street 1:1029 N SERICIN
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-6028
Practice Address - Country:US
Practice Address - Phone:480-274-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9344H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility