Provider Demographics
NPI:1861881393
Name:JOSE PASTRANO
Entity type:Organization
Organization Name:JOSE PASTRANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTRANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-842-1128
Mailing Address - Street 1:1641 PLUTARCO ELIAS CALLES
Mailing Address - Street 2:SUITE 10
Mailing Address - City:NOGALES
Mailing Address - State:SONORA
Mailing Address - Zip Code:84050
Mailing Address - Country:MX
Mailing Address - Phone:520-842-1128
Mailing Address - Fax:
Practice Address - Street 1:1641 PLUTARCO ELIAS CALLES
Practice Address - Street 2:SUITE 10
Practice Address - City:NOGALES
Practice Address - State:SONORA
Practice Address - Zip Code:84050
Practice Address - Country:MX
Practice Address - Phone:520-842-1128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ5682108122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty