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NPI Code Detail

MEDICARE: CHRISTIAN MEDINA PAGAN

MEDICARE: CHRISTIAN MEDINA PAGAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianFL

General Provider Information

NPI Number : 1710855812
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTIAN MEDINA PAGAN
Provider Business Mailing Address
First Line : 917 WASHINGTON PALM LOOP UNIT 917.5
Second Line :
City : DAVENPORT
State : FL
Zip : 33897-1652
Country : US
Telephone Number : 407-697-4812
Fax Number :
Provider Business Practice Location Address
First Line : 6421 N FLORIDA AVE STE D-1458
Second Line :
City : TAMPA
State : FL
Zip : 33604-6007
Country : US
Telephone Number : 813-409-4122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2025
Last Update Date : 02/18/2026

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Directions to “ CHRISTIAN MEDINA PAGAN ” Practice Location

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