Provider Demographics
NPI:1154464501
Name:PAGAN, LUIS JOSE (LPN)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:JOSE
Last Name:PAGAN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 442, BOX 606
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042
Mailing Address - Country:DE
Mailing Address - Phone:4-962-2117
Mailing Address - Fax:
Practice Address - Street 1:CMR 442, BOX 606
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09042
Practice Address - Country:DE
Practice Address - Phone:4-962-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197466164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse