Provider Demographics
NPI:1790442721
Name:PAGAN PACHECO, KARLA MICHELLE
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:MICHELLE
Last Name:PAGAN PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36500 S GRATIOT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1772
Mailing Address - Country:US
Mailing Address - Phone:586-493-3740
Mailing Address - Fax:586-493-3720
Practice Address - Street 1:36500 S GRATIOT AVE STE 202
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-1772
Practice Address - Country:US
Practice Address - Phone:586-493-3740
Practice Address - Fax:586-493-3720
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program