Provider Demographics
NPI:1114541224
Name:PAGAN, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:PAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 8 BOX 308
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731-9448
Mailing Address - Country:US
Mailing Address - Phone:787-340-4658
Mailing Address - Fax:
Practice Address - Street 1:PARCELAS MARUENO
Practice Address - Street 2:133 MANUEL ALONSO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731-9448
Practice Address - Country:US
Practice Address - Phone:787-340-4658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5295183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician