Provider Demographics
NPI:1326626037
Name:PAGAN RIVERA, ROBERTO E (DC)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:E
Last Name:PAGAN RIVERA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3286
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3286
Mailing Address - Country:US
Mailing Address - Phone:787-805-0707
Mailing Address - Fax:787-652-4795
Practice Address - Street 1:#63 W CALLE MENDEZ VIGO
Practice Address - Street 2:EDIFICIO TORRE DE HOSTOS OF. 1D
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-805-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR770OtherSTATE LICENSE