Healthcare Provider Details

I. General information

NPI: 1881138410
Provider Name (Legal Business Name): TIMOTHY PATRICK PAGANO PHD, ABPP, MSCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 MDG 31 NIGHTINGALE RD
EDWARDS AFB CA
93523
US

IV. Provider business mailing address

412 MDG 30 NIGHTINGALE RD
EDWARDS AFB CA
93523
US

V. Phone/Fax

Practice location:
  • Phone: 661-277-5291
  • Fax:
Mailing address:
  • Phone: 661-277-2397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number5971567
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number5971567
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: