Healthcare Provider Details

I. General information

NPI: 1720919624
Provider Name (Legal Business Name): NICOLE M PAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. ALTURAS DE SANS SOUCI A25 CALLE 3
BAYAMON PR
00957-4384
US

IV. Provider business mailing address

URBANIZACION ALTURAS DE SANS SOUCI A25 CALLE 3
BAYAMON PR
00957-4384
US

V. Phone/Fax

Practice location:
  • Phone: 787-475-0820
  • Fax:
Mailing address:
  • Phone: 787-475-0820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8492
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: