Healthcare Provider Details

I. General information

NPI: 1164946091
Provider Name (Legal Business Name): STEPHANIE PAGAN TORRES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BRENNER AVE
SALISBURY NC
28144-2515
US

IV. Provider business mailing address

1675 AZURE LN UNIT 203
WINSTON SALEM NC
27127-3249
US

V. Phone/Fax

Practice location:
  • Phone: 800-706-9126
  • Fax:
Mailing address:
  • Phone: 336-529-3664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: