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General NPI Number Information
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NPI Number | 1043200843
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Entity Type | Individual
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Provider Name | DR. LUIS A PACHECO OLIVERAS
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Gender | Male
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | CALLE LUIS MUNOZ RIVERA #39 EDIFICIO YOED OFICINA NO 3
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City | SABANA GRANDE
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State | PUERTO RICO
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Zip | 00637
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Country | UM
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Telephone | 787-873-4948
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Fax | 787-873-4948
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Provider Business Mailing Address
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Address Line | STREET NO 39 AVE LUIS MUNOZ RIVERA EDIFICIO YOED
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City | SABANA GRANDE
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State | PR
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Zip | 00683-1523
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 15510
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License Number State | PR
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