Provider Demographics
NPI:1669730024
Name:PACHECO, RICARDO BURGOS (PSICOLOGO)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:BURGOS
Last Name:PACHECO
Suffix:
Gender:M
Credentials:PSICOLOGO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION HACIENDA FLORIDA ,CALLE ALELI 591
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00698
Mailing Address - Country:UM
Mailing Address - Phone:787-856-2117
Mailing Address - Fax:
Practice Address - Street 1:18 CALLE SAN ISIDRO
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1855
Practice Address - Country:US
Practice Address - Phone:787-477-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3985103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1014Medicare PIN