Provider Demographics
NPI:1275200180
Name:PACHECO, MAYRA (CRNA)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. EL MADRIGAL
Mailing Address - Street 2:CALLE 4 E 24
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-1412
Mailing Address - Country:US
Mailing Address - Phone:787-901-3343
Mailing Address - Fax:
Practice Address - Street 1:URB. EL MADRIGAL
Practice Address - Street 2:CALLE 4 E 24
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-1412
Practice Address - Country:US
Practice Address - Phone:787-901-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR135759367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered