MEDICARE: ANDREINA BRACHO PACHECO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN 21458	FL

General Provider Information

NPI Number	:	1073940730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREINA BRACHO PACHECO

Provider Business Mailing Address
First Line	:	430 BRECHIN DR
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-4605
Country	:	US
Telephone Number	:	407-592-2474
Fax Number	:

Provider Business Practice Location Address
First Line	:	8255 LEE VISTA BLVD STE F-G
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829-8018
Country	:	US
Telephone Number	:	407-810-0450
Fax Number	:	407-641-9912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2013
Last Update Date	:	01/04/2022

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Directions to “ ANDREINA BRACHO PACHECO ” Practice Location

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