Provider Demographics
NPI:1740670611
Name:PASTRANA, FERNANDO JR (PHD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:PASTRANA
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HUEY P LONG AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-5971
Mailing Address - Country:US
Mailing Address - Phone:504-366-1377
Mailing Address - Fax:504-366-4518
Practice Address - Street 1:310 HUEY P LONG AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5971
Practice Address - Country:US
Practice Address - Phone:504-366-1377
Practice Address - Fax:504-366-4518
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1295103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical