Healthcare Provider Details

I. General information

NPI: 1265425516
Provider Name (Legal Business Name): JOHN M PAGAN PADILLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 AVE FD ROOSEVELT LA TORRE DE PLAZA SUITE 902
SAN JUAN PR
00918-8001
US

IV. Provider business mailing address

525 AVE FD ROOSEVELT LA TORRE DE PLAZA SUITE 902
SAN JUAN PR
00918-8001
US

V. Phone/Fax

Practice location:
  • Phone: 787-281-7120
  • Fax: 787-281-7140
Mailing address:
  • Phone: 787-281-7120
  • Fax: 787-281-7140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number11909
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: