MEDICARE: JARED R PAGAN RBT

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	106S00000X	Behavior Technician	RBT-18-73677	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942772868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED R PAGAN RBT

Provider Business Mailing Address
First Line	:	3018 BLAINE CIR
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32738-5327
Country	:	US
Telephone Number	:	386-848-8114
Fax Number	:

Provider Business Practice Location Address
First Line	:	4647 CLYDE MORRIS BLVD
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-3000
Country	:	US
Telephone Number	:	386-767-3752
Fax Number	:	386-767-4319

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

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	04/25/2019

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