Provider Demographics
NPI:1285691402
Name:PABON, EDUARDA (MD)
Entity type:Individual
Prefix:
First Name:EDUARDA
Middle Name:
Last Name:PABON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4422
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-4422
Mailing Address - Country:US
Mailing Address - Phone:787-858-2580
Mailing Address - Fax:787-858-2385
Practice Address - Street 1:CARR 2 KM 39.5 HOSPITAL WILMA N VAZQUEZ
Practice Address - Street 2:CALL BOX 7001
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00694-7001
Practice Address - Country:US
Practice Address - Phone:787-858-2580
Practice Address - Fax:787-858-2385
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2690208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD08230Medicare UPIN
PR21527DMedicare ID - Type Unspecified