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General NPI Number Information
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NPI Number | 1881138410
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Entity Type | Individual
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Provider Name | TIMOTHY PATRICK PAGANO PHD, ABPP, MSCP
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Gender | Male
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Dates
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Enumeration Date | 12/16/2016
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 412 MDG 31 NIGHTINGALE RD
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City | EDWARDS AFB
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State | CA
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Zip | 93523
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Country | US
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Telephone | 661-277-5291
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Fax |
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Provider Business Mailing Address
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Address Line | 412 MDG 30 NIGHTINGALE RD
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City | EDWARDS AFB
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State | CA
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Zip | 93523
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Country | US
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Telephone | 661-277-2397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 5971567
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 5971567
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License Number State | ID
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