Healthcare Provider Details

I. General information

NPI: 1205290673
Provider Name (Legal Business Name): CARLOS JAVIER PAGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CARLOS JAVIER PAGAN RODRIGUEZ

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 S PARSONS AVE
BRANDON FL
33511-6063
US

IV. Provider business mailing address

4033 TAMPA RD STE 101
OLDSMAR FL
34677-3224
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-4553
  • Fax: 813-681-1191
Mailing address:
  • Phone: 813-854-2003
  • Fax: 813-855-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME139856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: