Provider Demographics
NPI:1740285626
Name:PAGAN MIRANDA, ENID (MD)
Entity type:Individual
Prefix:DR
First Name:ENID
Middle Name:
Last Name:PAGAN MIRANDA
Suffix:
Gender:F
Credentials:MD
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 3571
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-0571
Mailing Address - Country:US
Mailing Address - Phone:787-785-2870
Mailing Address - Fax:787-288-4152
Practice Address - Street 1:MARGINAL MAGNOLIA GARDENS A35 CALLE 1
Practice Address - Street 2:MAGNOLIA GARDENS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-785-2870
Practice Address - Fax:787-288-4152
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10041208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF18832Medicare UPIN