Healthcare Provider Details

I. General information

NPI: 1316140486
Provider Name (Legal Business Name): CARMEN PAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE.GENERAL RAMEY #1052 POBLADO SAN ANTONIO
AGUADILLA PR
00690-0583
US

IV. Provider business mailing address

PO BOX 583
SAN ANTONIO PR
00690-0583
US

V. Phone/Fax

Practice location:
  • Phone: 787-890-3340
  • Fax: 787-890-1233
Mailing address:
  • Phone: 787-877-4395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: