Healthcare Provider Details

I. General information

NPI: 1407619075
Provider Name (Legal Business Name): BRAYAN ABDIEL PAGAN RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 S CONGRESS AVE FL 1149
ATLANTIS FL
33462-1149
US

IV. Provider business mailing address

5301 S CONGRESS AVE
ATLANTIS FL
33462-1149
US

V. Phone/Fax

Practice location:
  • Phone: 561-850-6366
  • Fax: 561-642-3685
Mailing address:
  • Phone: 561-850-6366
  • Fax: 561-642-3685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: