Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DN 13518 | FL |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 2043 | PR |
NPI | 1093839771 |
---|---|
Provider Name | Miguel Pastrana Laborde |
First Address | San Sebastian, PR 00685-1678 |
Second Address | San Sebastian, PR 00685-3216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 19/10/2016 |