Healthcare Provider Details

I. General information

NPI: 1114751104
Provider Name (Legal Business Name): GUSTAVO PAGAN TORRES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. HACIENDA FLORIDA 790 CALLE MIRAMELINDA
YAUCO PR
00698
US

IV. Provider business mailing address

URB. HACIENDA FLORIDA 790 CALLE MIRAMELINDA
YAUCO PR
00698
US

V. Phone/Fax

Practice location:
  • Phone: 787-317-8726
  • Fax:
Mailing address:
  • Phone: 787-317-8726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24524
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17137-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: