Provider Demographics
NPI:1134360787
Name:PAYAN, POMPILIO M
Entity type:Individual
Prefix:
First Name:POMPILIO
Middle Name:M
Last Name:PAYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11003 W OKEECHOBEE RD
Mailing Address - Street 2:UNIT 101
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4238
Mailing Address - Country:US
Mailing Address - Phone:305-979-5477
Mailing Address - Fax:
Practice Address - Street 1:11003 W OKEECHOBEE RD
Practice Address - Street 2:UNIT 101
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4238
Practice Address - Country:US
Practice Address - Phone:305-979-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-03-0821103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst