1720055700 NPI number — DR. HILDA L PAGAN AUD

Table of content: DR. HILDA L PAGAN AUD (NPI 1720055700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720055700 NPI number — DR. HILDA L PAGAN AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAGAN
Provider First Name:
HILDA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1720055700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 PLAZA PRADERA STE 20
Provider Second Line Business Mailing Address:
PMB 103
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-288-4140
Provider Business Mailing Address Fax Number:
787-288-4125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COMERIO AVE DD-8 RIVERVIEW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-288-4140
Provider Business Practice Location Address Fax Number:
787-288-4125
Provider Enumeration Date:
03/08/2006

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: 231H00000X , with the licence number:  513 , 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)

  • Identifier: 60259 . This is a "BLUE SHIELD PROVIDER NUMB" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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