Healthcare Provider Details

I. General information

NPI: 1992619845
Provider Name (Legal Business Name): DAIANELYS PAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONSOLIDATED MALL, LOCAL C21 AV. JOSE GAUTIER BENITEZ
CAGUAS PR
00725
US

IV. Provider business mailing address

URBANIZACION REPARTO MONTELLANO CALLE A F13
CAYEY PR
00736
US

V. Phone/Fax

Practice location:
  • Phone: 787-653-4001
  • Fax:
Mailing address:
  • Phone: 787-326-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8823
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: