Provider Demographics
NPI:1669106688
Name:PASTORA, YADDER ALEXANDER
Entity type:Individual
Prefix:
First Name:YADDER
Middle Name:ALEXANDER
Last Name:PASTORA
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 1:1839 ELIZABETH WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5135
Mailing Address - Country:US
Mailing Address - Phone:925-329-8171
Mailing Address - Fax:
Practice Address - Street 1:1839 ELIZABETH WAY
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5135
Practice Address - Country:US
Practice Address - Phone:925-329-8171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12345678OtherACCESS 2 CARE