Healthcare Provider Details

I. General information

NPI: 1467657262
Provider Name (Legal Business Name): CIRUGIA GENERAL Y PERIFEROVASCULAR DEL NORESTE, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSP. HIMA SAN PABLO OFICINA #7
FAJARDO PR
00738
US

IV. Provider business mailing address

PO BOX 70005 PMB 234
FAJARDO PR
00738-7005
US

V. Phone/Fax

Practice location:
  • Phone: 787-655-0505
  • Fax: 787-863-2145
Mailing address:
  • Phone: 787-655-0505
  • Fax: 787-863-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number9988
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE L PAGAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-655-0505