Provider Demographics
NPI:1073940730
Name:BRACHO PACHECO, ANDREINA
Entity Type:Individual
Prefix:
First Name:ANDREINA
Middle Name:
Last Name:BRACHO PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 BRECHIN DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4605
Mailing Address - Country:US
Mailing Address - Phone:407-592-2474
Mailing Address - Fax:
Practice Address - Street 1:8255 LEE VISTA BLVD STE F-G
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8018
Practice Address - Country:US
Practice Address - Phone:407-810-0450
Practice Address - Fax:407-641-9912
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 214581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry