Provider Demographics
NPI:1821175605
Name:PACHECO, OLGA E (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:E
Last Name:PACHECO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3298
Mailing Address - Street 2:BAYAMON GARDENS STATION
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958
Mailing Address - Country:US
Mailing Address - Phone:787-279-5037
Mailing Address - Fax:787-797-0007
Practice Address - Street 1:CARR 167 KM 186
Practice Address - Street 2:FRENTE A REXVILLE PLAZA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-279-5037
Practice Address - Fax:787-279-7460
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11776207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G41681Medicare UPIN