Provider Demographics
NPI:1477665313
Name:PAGAN-DIAZ, DENISE S (OD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:S
Last Name:PAGAN-DIAZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CARR 861
Mailing Address - Street 2:APT 80
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9313
Mailing Address - Country:US
Mailing Address - Phone:787-474-0881
Mailing Address - Fax:787-474-0881
Practice Address - Street 1:LOCAL 39 SANTA ROSA MALL
Practice Address - Street 2:STE 7
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-787-6334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR531152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84361OtherTRIPLE S
PR84361PAOtherTRIPLE C
PR84361OtherTRIPLE S