MEDICARE: DR. PAULETTE C. PACHECO-LOPEZ M.D.

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	207Y00000X	Otolaryngology Physician	18856	PR
2	207Y00000X	Otolaryngology Physician	D0075253	MD

General Provider Information

NPI Number	:	1568657930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULETTE C. PACHECO-LOPEZ M.D.

Provider Business Mailing Address
First Line	:	3950 CARR 176
Second Line	:	GARDEN VALLEY CLUB APT 108
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6737
Country	:	US
Telephone Number	:	787-671-1382
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 CARR 176
Second Line	:	GARDEN VALLEY CLUB APT 108
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6737
Country	:	US
Telephone Number	:	787-671-1382
Fax Number	:

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

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	08/11/2014

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