Healthcare Provider Details

I. General information

NPI: 1457275984
Provider Name (Legal Business Name): MARGIE BERENICE PACHECO CPL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5512 CALLE JULIO MEDINA MORENO
PONCE PR
00716-1357
US

IV. Provider business mailing address

5512 CALLE JULIO MEDINA MORENO
PONCE PR
00716-1357
US

V. Phone/Fax

Practice location:
  • Phone: 939-639-5353
  • Fax:
Mailing address:
  • Phone: 939-639-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4622
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: