Provider Demographics
NPI:1669892345
Name:PAGAN AGOSTO, ISABEL
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:PAGAN AGOSTO
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:PO BOX 1586
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-5501
Mailing Address - Country:US
Mailing Address - Phone:787-601-1135
Mailing Address - Fax:
Practice Address - Street 1:URB ORTA #12 CALLE B
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-5501
Practice Address - Country:US
Practice Address - Phone:787-601-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2319993343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)