Provider Demographics
NPI:1568093060
Name:MARCANTONI PACHECO, MICHELE C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:C
Last Name:MARCANTONI 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:BB13 CALLE LAUREL S
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4753
Mailing Address - Country:US
Mailing Address - Phone:787-402-3170
Mailing Address - Fax:
Practice Address - Street 1:CALLE LAUREL SUR BB13
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646
Practice Address - Country:US
Practice Address - Phone:787-402-3170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22509208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice