Healthcare Provider Details

I. General information

NPI: 1407449671
Provider Name (Legal Business Name): PACHY JARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/18/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 S OCEAN DRIVE
HALLANDALE BEACH FL
33009
US

IV. Provider business mailing address

82 NASSAU ST # 60456
NEW YORK NY
10038-3703
US

V. Phone/Fax

Practice location:
  • Phone: 914-564-2494
  • Fax:
Mailing address:
  • Phone: 914-564-2494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: