Provider Demographics
NPI:1376719997
Name:PAGAN, ISRAEL (MA)
Entity Type:Individual
Prefix:MR
First Name:ISRAEL
Middle Name:
Last Name:PAGAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CALLE GENERALIFE
Mailing Address - Street 2:PASEO DE LA ALHAMBRA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-6872
Mailing Address - Country:US
Mailing Address - Phone:787-630-0855
Mailing Address - Fax:
Practice Address - Street 1:40 CALLE GENERALIFE
Practice Address - Street 2:PASEO DE LA ALHAMBRA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-6872
Practice Address - Country:US
Practice Address - Phone:787-630-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-03
Last Update Date:2008-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1928101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)