Provider Demographics
NPI:1326121013
Name:GONZALEZ-PAGAN, ENID (OD)
Entity Type:Individual
Prefix:
First Name:ENID
Middle Name:
Last Name:GONZALEZ-PAGAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ENID
Other - Middle Name:
Other - Last Name:GONZALEZ-PAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:141 CALLE ORQUIDEA
Mailing Address - Street 2:URB. EL VALLE
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-2516
Mailing Address - Country:US
Mailing Address - Phone:787-899-1244
Mailing Address - Fax:787-899-1244
Practice Address - Street 1:15 65 DE INFANTERIA S
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-2010
Practice Address - Country:US
Practice Address - Phone:787-899-1244
Practice Address - Fax:787-899-1244
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR527152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist