Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 1865 | PR |
NPI | 1053458323 |
---|---|
Provider Name | Dr. Elaine M. Pagan |
First Address | Trujillo Alto, PR 00977-1527 |
Second Address | Rio Piedras, PR 00927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |