MEDICARE: MRS. YASHAIRA M PACHECO RODRIGUEZ PHL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4081	PR

General Provider Information

NPI Number	:	1326659061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YASHAIRA M PACHECO RODRIGUEZ PHL

Provider Business Mailing Address
First Line	:	53 CALLE CALIFORNIA
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00730-3594
Country	:	US
Telephone Number	:	787-974-6256
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 AVE DE DIEGO STE 601
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1740
Country	:	US
Telephone Number	:	787-723-6868
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2020
Last Update Date	:	10/24/2024

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Directions to “ MRS. YASHAIRA M PACHECO RODRIGUEZ PHL” Practice Location

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