Provider Demographics
NPI:1174852826
Name:PAGAN, EVELYN
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:PAGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:PAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OCCUPATIONAL THERAPI
Mailing Address - Street 1:PO BOX 1283
Mailing Address - Street 2:PMB 457
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-1283
Mailing Address - Country:US
Mailing Address - Phone:787-605-3154
Mailing Address - Fax:787-733-0827
Practice Address - Street 1:AVE. PADRE RIVERA #4
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-656-5360
Practice Address - Fax:787-656-5356
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR590172V00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No174400000XOther Service ProvidersSpecialist