MEDICARE: DR. JOHANNA PAGAN M.D.

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
1	208D00000X	General Practice Physician	17735	PR

General Provider Information

NPI Number	:	1831425743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHANNA PAGAN M.D.

Provider Business Mailing Address
First Line	:	G.E.S.
Second Line	:	3ER PISO EDF JESUS T. PINERO AVE. FERNANDEZ JUNCOS ESQ.
City	:	CAROLINA
State	:	PR
Zip	:	00985
Country	:	US
Telephone Number	:	787-284-3737
Fax Number	:	787-284-3700

Provider Business Practice Location Address
First Line	:	CALLE CENA FINAL 900 PARADA 15
Second Line	:	LA TORRE DE PLAZA SUITE 614
City	:	SAN JUAN
State	:	PR
Zip	:	00920-0000
Country	:	US
Telephone Number	:	787-768-1365
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2009
Last Update Date	:	09/11/2012

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