Healthcare Provider Details

I. General information

NPI: 1508782004
Provider Name (Legal Business Name): ALICIA PAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLEO PAGAN

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1457 FLATBUSH AVE APT 204
BROOKLYN NY
11210-2452
US

IV. Provider business mailing address

1457 FLATBUSH AVE APT 204
BROOKLYN NY
11210-2452
US

V. Phone/Fax

Practice location:
  • Phone: 917-470-1692
  • Fax: 917-470-1692
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: