Provider Demographics
NPI:1114901899
Name:PACHECO, ILUMINADE (MEDICAL TECHNOLOGYST)
Entity Type:Individual
Prefix:MRS
First Name:ILUMINADE
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:MEDICAL TECHNOLOGYST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ANGEL GREGORIO MARTNIEZ
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637
Mailing Address - Country:US
Mailing Address - Phone:787-804-1844
Mailing Address - Fax:787-804-1844
Practice Address - Street 1:9 ANGEL GREGORIO MARTNIEZ
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-804-1844
Practice Address - Fax:787-804-1844
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2829246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
30158Medicare ID - Type Unspecified