Provider Demographics
NPI:1518912682
Name:PACHECO, RAYSA R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYSA
Middle Name:R
Last Name:PACHECO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FLAMBOYAN 159
Mailing Address - Street 2:LA SERRANIA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-0001
Mailing Address - Country:US
Mailing Address - Phone:787-653-6474
Mailing Address - Fax:
Practice Address - Street 1:FLAMBOYAN 159
Practice Address - Street 2:LA SERRANIA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0001
Practice Address - Country:US
Practice Address - Phone:787-653-6474
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15250208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15250OtherLICENCE
PRI51565Medicare UPIN
PR23989Medicare ID - Type Unspecified