1699987412 NPI number — MS. MARIA DEL CARMEN PAGAN LOPEZ

Table of content: MS. MARIA DEL CARMEN PAGAN LOPEZ (NPI 1699987412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699987412 NPI number — MS. MARIA DEL CARMEN PAGAN LOPEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAGAN LOPEZ
Provider First Name:
MARIA
Provider Middle Name:
DEL CARMEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAGAN
Provider Other First Name:
MARIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699987412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
61 CALLE TOPACIO
Provider Second Line Business Mailing Address:
VILLA BLANCA
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725-1952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-777-3535
Provider Business Mailing Address Fax Number:
787-763-1093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY PEDIATRIC HOSPITAL (CENTRO PEDIATRICO)
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00919-1079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-777-3535
Provider Business Practice Location Address Fax Number:
787-763-1093
Provider Enumeration Date:
05/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  2553 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)