MEDICARE: LEAH PACHECO

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	163W00000X	Registered Nurse	9469002	FL

General Provider Information

NPI Number	:	1538748256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH PACHECO

Provider Business Mailing Address
First Line	:	5381 SW 38TH WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-8226
Country	:	US
Telephone Number	:	954-806-5259
Fax Number	:

Provider Business Practice Location Address
First Line	:	5381 SW 38TH WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-8226
Country	:	US
Telephone Number	:	954-806-5259
Fax Number	:

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

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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Directions to “ LEAH PACHECO ” Practice Location

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