Provider Demographics
NPI:1356600936
Name:PAGAN CARDIO VASCULAR, PSC
Entity type:Organization
Organization Name:PAGAN CARDIO VASCULAR, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-901-4025
Mailing Address - Street 1:1854 AVE MCLEARY
Mailing Address - Street 2:CHATEAU MCLEARY #13
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1301
Mailing Address - Country:US
Mailing Address - Phone:631-901-4025
Mailing Address - Fax:
Practice Address - Street 1:MANATI MEDICAL CENTER-LABORATORIO VASCULAR
Practice Address - Street 2:URB ATENAS CALLE HERNANDEZ CARRION PRIMER PISO
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-621-3777
Practice Address - Fax:787-621-3776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR128602086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0089844Medicare PIN