Provider Demographics
NPI:1205817400
Name:PAGAN RIVERA, YOLANDA (MD)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:PAGAN RIVERA
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:AVE E POL 497 #78
Mailing Address - Street 2:LA CUMBRE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-792-0054
Mailing Address - Fax:787-782-6230
Practice Address - Street 1:CARRETA 2 KM 7.1
Practice Address - Street 2:SECTOR JUAN DOMINGO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-781-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10560208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG04549Medicare UPIN
PR83312Medicare ID - Type Unspecified