Healthcare Provider Details

I. General information

NPI: 1306836234
Provider Name (Legal Business Name): ROSA M PACHECO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2005
Last Update Date: 03/07/2023
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 S SEMORAN BLVD
ORLANDO FL
32807-1457
US

IV. Provider business mailing address

121 S ORANGE AVE STE 940
ORLANDO FL
32801-3234
US

V. Phone/Fax

Practice location:
  • Phone: 407-382-1376
  • Fax: 321-235-3232
Mailing address:
  • Phone: 321-332-6947
  • Fax: 407-658-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME88490
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: