Healthcare Provider Details

I. General information

NPI: 1467444166
Provider Name (Legal Business Name): LIZZETTE PAGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date: 04/10/2006
Reactivation Date: 06/27/2006

III. Provider practice location address

1823 E MCDOWELL RD
PHOENIX AZ
85006-3052
US

IV. Provider business mailing address

PO BOX 20631
PHOENIX AZ
85036-0631
US

V. Phone/Fax

Practice location:
  • Phone: 602-716-5700
  • Fax: 602-716-5842
Mailing address:
  • Phone: 602-716-5700
  • Fax: 602-716-5842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAZ27535
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: