Provider Demographics
NPI:1427520865
Name:ARROYO PAGAN, IDA PAULIZA (MD)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:PAULIZA
Last Name:ARROYO PAGAN
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 1077
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1077
Mailing Address - Country:US
Mailing Address - Phone:787-402-8090
Mailing Address - Fax:787-735-4887
Practice Address - Street 1:156 CALLE BALDORIOTY N
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3218
Practice Address - Country:US
Practice Address - Phone:787-735-4887
Practice Address - Fax:787-735-4887
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21159208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice