Basic Information
| Provider Information | |||||||||
| NPI: | 1871654160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PASTOR | ||||||||
| FirstName: | MARIA TERESA | ||||||||
| MiddleName: | GALARPE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PASTOR | ||||||||
| OtherFirstName: | MARIA | ||||||||
| OtherMiddleName: | TERESA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1703 TERMINO AVE. SUITE 206 | ||||||||
| Address2: | 206 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629610210 | ||||||||
| FaxNumber: | 5629610212 | ||||||||
| Practice Location | |||||||||
| Address1: | 1703 TERMINO AVE. SUITE 206 | ||||||||
| Address2: | 206 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629610210 | ||||||||
| FaxNumber: | 5629610212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | A46377 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 00A463771 | 05 | CA | MEDICAID |