Provider Demographics
NPI:1518079417
Name:PACHECO, YOMAIRA (CPHT)
Entity Type:Individual
Prefix:
First Name:YOMAIRA
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ST. URB MARIA ANTONIA
Mailing Address - Street 2:H-634
Mailing Address - City:GUANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653
Mailing Address - Country:US
Mailing Address - Phone:787-821-1105
Mailing Address - Fax:
Practice Address - Street 1:3 ST. URB MARIA ANTONIA
Practice Address - Street 2:H-634
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653
Practice Address - Country:US
Practice Address - Phone:787-821-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5655183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5655Medicare UPIN