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General NPI Number Information
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NPI Number | 1942639489
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Entity Type | Organization
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Legal Business Name | AGADA, LLC
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | BA-22 AVE. MONSERRATE CALLE TULIPAN
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City | CAROLINA
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State | PR
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Zip | 00983-3309
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Country | US
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Telephone | 787-752-6505
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Fax | 787-752-6505
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Provider Business Mailing Address
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Address Line | PO BOX 362352
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City | SAN JUAN
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State | PR
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Zip | 00936-2352
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Country | US
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Telephone | 787-752-6505
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Fax | 787-752-6505
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Authorized Official
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Title or Position | DRA
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Name | DR. ADA G PAISAN
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Credential | MD
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Telephone | 787-752-6505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 14387
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License Number State | PR
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