Provider Demographics
NPI:1720716558
Name:PAGAN LIZARDI, JOEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:PAGAN LIZARDI
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:CALLE 28 T--13 TURABO GARDENS 2DA SECC
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-5947
Mailing Address - Country:US
Mailing Address - Phone:787-202-6360
Mailing Address - Fax:
Practice Address - Street 1:CALLE 28 T--13 TURABO GARDENS 2DA SECC
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-5947
Practice Address - Country:US
Practice Address - Phone:787-202-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23614208D00000X
PR16450I390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice