Provider Demographics
NPI:1326039298
Name:PAGAN, MARIBEL (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIBEL
Middle Name:
Last Name:PAGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. PEDREGALES
Mailing Address - Street 2:180 CALLE GRANITO
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-538-1340
Mailing Address - Fax:787-887-1586
Practice Address - Street 1:URB. PEDREGALES
Practice Address - Street 2:180 CALLE GRANITO
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-538-1340
Practice Address - Fax:787-887-1586
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ07626Medicare UPIN