MEDICARE: DR. MAGDA LILIANA 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	122300000X	Dentist	0401415938	VA

General Provider Information

NPI Number	:	1699264424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAGDA LILIANA PACHECO

Provider Business Mailing Address
First Line	:	5848 STRADA CAPRI WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3274
Country	:	US
Telephone Number	:	201-336-2948
Fax Number	:

Provider Business Practice Location Address
First Line	:	5848 STRADA CAPRI WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3274
Country	:	US
Telephone Number	:	201-336-2948
Fax Number	:

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

Provider Enumeration Date	:	05/07/2018
Last Update Date	:	05/07/2018

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