Provider Demographics
NPI:1275743726
Name:PAGAN, LUCILA (MD)
Entity Type:Individual
Prefix:
First Name:LUCILA
Middle Name:
Last Name:PAGAN
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 1:21-8 CALLE 17
Mailing Address - Street 2:URB VILLA CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5752
Mailing Address - Country:US
Mailing Address - Phone:787-757-4343
Mailing Address - Fax:
Practice Address - Street 1:COMPLEJO CORRECIONAL DE BAYAMON
Practice Address - Street 2:AVE CENTRAL JUANITA FINAL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-288-8865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14207208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice