Provider Demographics
NPI:1396234142
Name:PAGAN LOPEZ, WILMAYRI
Entity type:Individual
Prefix:
First Name:WILMAYRI
Middle Name:
Last Name:PAGAN LOPEZ
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:HC 3 BOX 20755
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-8236
Mailing Address - Country:US
Mailing Address - Phone:939-439-4524
Mailing Address - Fax:
Practice Address - Street 1:1 AVE KENNEDY
Practice Address - Street 2:HOSPITAL BUEN SAMARITANO CARR 2 KM
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-819-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22097208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice