Provider Demographics
NPI:1689714602
Name:POU-PACHECO, JOSE M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:POU-PACHECO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:472 AVE. TITO CASTRO
Mailing Address - Street 2:EDIFICIO MARVESA SUITE #302
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4703
Mailing Address - Country:US
Mailing Address - Phone:787-842-2253
Mailing Address - Fax:787-842-2253
Practice Address - Street 1:472 AVE TITO CASTRO
Practice Address - Street 2:EDIFICIO MARVESA SUITE #302
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4703
Practice Address - Country:US
Practice Address - Phone:787-842-2253
Practice Address - Fax:787-842-2253
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR34662084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry