Provider Demographics
NPI:1457538159
Name:PACHECO SUAREZ, JOSE ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:PACHECO SUAREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:PACHECO SUAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1511 AVE PONCE DE LEON
Mailing Address - Street 2:CIUDADELA APT # 176
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-5001
Mailing Address - Country:US
Mailing Address - Phone:787-502-8020
Mailing Address - Fax:
Practice Address - Street 1:1511 AVE PONCE DE LEON
Practice Address - Street 2:APT 176
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-5001
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0181272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREQ104YOtherMEDICARE PTAN