Provider Demographics
NPI:1942639489
Name:AGADA, LLC
Entity type:Organization
Organization Name:AGADA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRA
Authorized Official - Prefix:DR
Authorized Official - First Name:ADA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAISAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-752-6505
Mailing Address - Street 1:PO BOX 362352
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2352
Mailing Address - Country:US
Mailing Address - Phone:787-752-6505
Mailing Address - Fax:787-752-6505
Practice Address - Street 1:BA-22 AVE. MONSERRATE CALLE TULIPAN
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3309
Practice Address - Country:US
Practice Address - Phone:787-752-6505
Practice Address - Fax:787-752-6505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGADA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14387208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH75678Medicare UPIN
PR21075Medicare PIN