Provider Demographics
NPI:1568657930
Name:PACHECO-LOPEZ, PAULETTE C (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:C
Last Name:PACHECO-LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAULETTE
Other - Middle Name:C
Other - Last Name:PACHECO-LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3950 CARR 176
Mailing Address - Street 2:GARDEN VALLEY CLUB APT 108
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6737
Mailing Address - Country:US
Mailing Address - Phone:787-671-1382
Mailing Address - Fax:
Practice Address - Street 1:3950 CARR 176
Practice Address - Street 2:GARDEN VALLEY CLUB APT 108
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6737
Practice Address - Country:US
Practice Address - Phone:787-671-1382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18856207Y00000X
MDD0075253207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology