Provider Demographics
NPI:1902066194
Name:PASTORE, MARC (SLP)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:PASTORE
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1586 W SAN MARCOS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4019
Mailing Address - Country:US
Mailing Address - Phone:760-891-7007
Mailing Address - Fax:760-471-7731
Practice Address - Street 1:1586 W SAN MARCOS BLVD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4019
Practice Address - Country:US
Practice Address - Phone:760-891-7007
Practice Address - Fax:760-471-7731
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist