Provider Demographics
NPI:1629842471
Name:PAGAN, ROSAURA CRISTINA (RBT)
Entity Type:Individual
Prefix:MRS
First Name:ROSAURA
Middle Name:CRISTINA
Last Name:PAGAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 LAPIS LN
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5425
Mailing Address - Country:US
Mailing Address - Phone:850-400-6098
Mailing Address - Fax:866-265-8817
Practice Address - Street 1:100 PREMIER DRIVE
Practice Address - Street 2:UNIT C
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539
Practice Address - Country:US
Practice Address - Phone:850-400-6098
Practice Address - Fax:866-265-8817
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-310244106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty