Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 445 | AK |
Y | 103T00000X | Psychologist | 445 | AK |
NPI | 1003828062 |
---|---|
Provider Name | Raymond Pastorino |
First Address | Portland, OR 97208-4105 |
Second Address | Anchorage, AK 99508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 15/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1029327 | (05) | AK |