Healthcare Provider Details

I. General information

NPI: 1184272874
Provider Name (Legal Business Name): CALEB S PACHECO MOLINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2019
Last Update Date: 02/07/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 AVE SEVERIANO CUEVAS HOSPITAL BUEN SAMARITANO LOBBY
AGUADILLA PR
00603
US

IV. Provider business mailing address

HOSPITAL BUEN SAMARITANO 18 AVE SEVERIANO CUEVAS, GROUND FLOOR
AGUADILLA PR
00603
US

V. Phone/Fax

Practice location:
  • Phone: 787-997-0101
  • Fax: 939-697-6262
Mailing address:
  • Phone: 787-997-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22368
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number22368
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: