Provider Demographics
NPI:1942794078
Name:PACHECO MIRANDA, BIANKINETTE
Entity Type:Individual
Prefix:
First Name:BIANKINETTE
Middle Name:
Last Name:PACHECO MIRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-0901
Mailing Address - Country:US
Mailing Address - Phone:787-448-5717
Mailing Address - Fax:
Practice Address - Street 1:INTERCEDE
Practice Address - Street 2:ACADEMIA PONCE INTERAMERICANA 2DO NIVEL 239 SABANETAS S
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:939-238-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR70322355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty