Provider Demographics
NPI:1427071760
Name:DE JESUS PAGAN, BRENDA MARANGEL (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:MARANGEL
Last Name:DE JESUS PAGAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10268 SW CAPTIVA DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-6402
Mailing Address - Country:US
Mailing Address - Phone:787-462-1542
Mailing Address - Fax:
Practice Address - Street 1:714 AVENUE C
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4189
Practice Address - Country:US
Practice Address - Phone:772-429-3400
Practice Address - Fax:772-252-7116
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13619208000000X
FLME142282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics