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General NPI Number Information
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NPI Number | 1780262592
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Entity Type | Individual
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Provider Name | ILEANA MARIA PACHECO-COLON
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Gender | Female
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Dates
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Enumeration Date | 04/01/2021
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 7700 N KENDALL DR STE 809
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City | MIAMI
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State | FL
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Zip | 33156-7597
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Country | US
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Telephone | 787-246-5944
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Fax |
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Provider Business Mailing Address
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Address Line | 5091 NW 7TH ST APT 1011
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City | MIAMI
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State | FL
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Zip | 33126-3474
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Country | US
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Telephone | 787-246-5944
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY12189
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License Number State | FL
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