Provider Demographics
NPI:1871352823
Name:PASTRANA, ITZAMAR
Entity type:Individual
Prefix:
First Name:ITZAMAR
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 1:81-4 CALLE INOCENCIO CRUZ
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-4960
Mailing Address - Country:US
Mailing Address - Phone:787-365-8214
Mailing Address - Fax:
Practice Address - Street 1:81-4 CALLE INOCENCIO CRUZ
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-4960
Practice Address - Country:US
Practice Address - Phone:787-365-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6668430390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program