Healthcare Provider Details

I. General information

NPI: 1578309829
Provider Name (Legal Business Name): CPM NEPHROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2024
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: 787-242-9540
  • Fax:
Mailing address:
  • Phone: 787-997-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CALEB S PACHECO MOLINA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-242-9540