Provider Demographics
NPI:1902251069
Name:PAGAN, ANTONIO JR (EDS)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:PAGAN
Suffix:JR
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10118 PINK CARNATION CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8814
Mailing Address - Country:US
Mailing Address - Phone:407-325-0027
Mailing Address - Fax:407-658-2879
Practice Address - Street 1:10118 PINK CARNATION CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-8814
Practice Address - Country:US
Practice Address - Phone:407-325-0027
Practice Address - Fax:407-658-2879
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health