Provider Demographics
NPI:1063663706
Name:PAGAN LA TORRE, MORAIMA (MD)
Entity Type:Individual
Prefix:
First Name:MORAIMA
Middle Name:
Last Name:PAGAN LA TORRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801307
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1307
Mailing Address - Country:US
Mailing Address - Phone:787-223-6537
Mailing Address - Fax:
Practice Address - Street 1:#5 CALLE SANTIAGO IGLESIAS
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-0000
Practice Address - Country:US
Practice Address - Phone:787-260-0087
Practice Address - Fax:787-260-0087
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR017362208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR017362OtherMEDICAL LICENSE