Provider Demographics
NPI:1275885618
Name:PAGAN, LISANDRA (TO)
Entity Type:Individual
Prefix:MRS
First Name:LISANDRA
Middle Name:
Last Name:PAGAN
Suffix:
Gender:F
Credentials:TO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION VILLA HILDA CALLE 7 E-5
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767
Mailing Address - Country:US
Mailing Address - Phone:787-206-4256
Mailing Address - Fax:
Practice Address - Street 1:STREET 7 E-5 URB. VILLA HILDA
Practice Address - Street 2:URB. VILLA HILDA
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-0000
Practice Address - Country:US
Practice Address - Phone:787-206-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR942225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist