Provider Demographics
NPI:1255855508
Name:PAGAN, MARIA DE LOURDES
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE LOURDES
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 1:30 CALLE VISTA AL BOSQUE
Mailing Address - Street 2:URB. BELLA VISTA ESTATES
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:787-393-8818
Mailing Address - Fax:
Practice Address - Street 1:30 CALLE VISTA AL BOSQUE
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-9339
Practice Address - Country:US
Practice Address - Phone:787-393-8818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program