Provider Demographics
NPI:1982912358
Name:PAGAN, CHARLENNE G
Entity Type:Individual
Prefix:
First Name:CHARLENNE
Middle Name:G
Last Name:PAGAN
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:I29 CALLE VIOLETA
Mailing Address - Street 2:REPTO VALENCIA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-4141
Mailing Address - Country:US
Mailing Address - Phone:787-598-2660
Mailing Address - Fax:
Practice Address - Street 1:CALLE VIOLETA I 29
Practice Address - Street 2:REPTO VALENCIA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-4141
Practice Address - Country:US
Practice Address - Phone:787-598-2660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR652156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician