Provider Demographics
NPI:1043200843
Name:PACHECO OLIVERAS, LUIS A
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:PACHECO OLIVERAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET NO 39 AVE LUIS MUNOZ RIVERA
Mailing Address - Street 2:EDIFICIO YOED
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA #39
Practice Address - Street 2:EDIFICIO YOED OFICINA NO 3
Practice Address - City:SABANA GRANDE
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00637
Practice Address - Country:UM
Practice Address - Phone:787-873-4948
Practice Address - Fax:787-873-4948
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15510208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI24146Medicare UPIN