Provider Demographics
NPI:1770914731
Name:FACHADO, ANA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:FACHADO
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:CALLE CM1 DR J PADILLA
Mailing Address - Street 2:5TA SECCION
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-393-0671
Mailing Address - Fax:
Practice Address - Street 1:400 CALLEJON TAMARINDO
Practice Address - Street 2:AVENIDA EDUARDO CONDEZ
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-1503
Practice Address - Country:US
Practice Address - Phone:787-393-0671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2608163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse