Provider Demographics
NPI:1598494262
Name:DE JESUS PAGAN, MARIA JOSE (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JOSE
Last Name:DE JESUS PAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REPARTO CURIEL A-10
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-236-1083
Mailing Address - Fax:
Practice Address - Street 1:B47 CALLE ELLIOT VELEZ
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4615
Practice Address - Country:US
Practice Address - Phone:787-884-6572
Practice Address - Fax:787-884-5498
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23460208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice