Provider Demographics
NPI:1801945522
Name:PAGAN CARDONA, JANNISSE (MD)
Entity type:Individual
Prefix:DR
First Name:JANNISSE
Middle Name:
Last Name:PAGAN CARDONA
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 1:128 CALLE ALBORADA
Mailing Address - Street 2:PASEO DEL PRADO
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7616
Mailing Address - Country:US
Mailing Address - Phone:787-276-6638
Mailing Address - Fax:
Practice Address - Street 1:1815 ROAD #2 KM 11.7
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7279
Practice Address - Country:US
Practice Address - Phone:787-780-9069
Practice Address - Fax:787-780-2121
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11880207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25271Medicare PIN