Provider Demographics
NPI:1134473515
Name:LIZZETTE PAGAN PLLC
Entity Type:Organization
Organization Name:LIZZETTE PAGAN PLLC
Other - Org Name:MY PEDIATRIC PLACE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-716-5700
Mailing Address - Street 1:1823 E MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3052
Mailing Address - Country:US
Mailing Address - Phone:602-716-5700
Mailing Address - Fax:602-716-5842
Practice Address - Street 1:1823 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3052
Practice Address - Country:US
Practice Address - Phone:602-716-5700
Practice Address - Fax:602-716-5842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ272532080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty