Basic Information
| Provider Information | |||||||||
| NPI: | 1194269555 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PABON | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PABON-RIVERA | ||||||||
| OtherFirstName: | SAMUEL | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 365067 | ||||||||
| Address2: | UPR-MEDICAL SCIENCES CAMPUS, DEPARTMENT OF PEDIATRICS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009265067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877564020 | ||||||||
| FaxNumber: | 7877773227 | ||||||||
| Practice Location | |||||||||
| Address1: | P3 CALLE D-OESTE | ||||||||
| Address2: | CIUDAD UNIVERSITARIA | ||||||||
| City: | TRUJILLO ALTO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872486575 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2016 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 14345 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.