MEDICARE: MRS. SONNET PACHECO RDMS

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	2085U0001X	Diagnostic Ultrasound Physician	118950	IL

General Provider Information

NPI Number	:	1376360347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SONNET PACHECO RDMS

Provider Business Mailing Address
First Line	:	4043 N MARMORA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-1728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5851 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2609
Country	:	US
Telephone Number	:	312-560-5585
Fax Number	:

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

Provider Enumeration Date	:	09/23/2024
Last Update Date	:	09/23/2024

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