Provider Demographics
NPI:1467657262
Name:CIRUGIA GENERAL Y PERIFEROVASCULAR DEL NORESTE, CSP
Entity Type:Organization
Organization Name:CIRUGIA GENERAL Y PERIFEROVASCULAR DEL NORESTE, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-655-0505
Mailing Address - Street 1:PO BOX 70005
Mailing Address - Street 2:PMB 234
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-7005
Mailing Address - Country:US
Mailing Address - Phone:787-655-0505
Mailing Address - Fax:787-863-2145
Practice Address - Street 1:HOSP. HIMA SAN PABLO
Practice Address - Street 2:OFICINA #7
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-655-0505
Practice Address - Fax:787-863-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9988174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty