Provider Demographics
NPI:1013989722
Name:MATTEI PACHECO, ANTONIO J
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:J
Last Name:MATTEI PACHECO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 AVE DE DIEGO
Mailing Address - Street 2:SUITE 300 EDIF. SAN JUAN HEALTH CENTRE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2300
Mailing Address - Country:US
Mailing Address - Phone:787-729-0606
Mailing Address - Fax:787-729-4242
Practice Address - Street 1:150 AVE DE DIEGO
Practice Address - Street 2:SUITE 300 EDIF. SAN JUAN HEALTH CENTRE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2300
Practice Address - Country:US
Practice Address - Phone:787-729-0606
Practice Address - Fax:787-729-4242
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12267207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR062115OtherCRUZ AZUL
PR9110060OtherHUMANA
PR89143OtherTRIPLE S
PRH82877Medicare UPIN
PR89143Medicare ID - Type Unspecified