Provider Demographics
NPI:1780262592
Name:PACHECO-COLON, ILEANA MARIA
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:MARIA
Last Name:PACHECO-COLON
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 1:5091 NW 7TH ST APT 1011
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3474
Mailing Address - Country:US
Mailing Address - Phone:787-246-5944
Mailing Address - Fax:
Practice Address - Street 1:7700 N KENDALL DR STE 809
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7597
Practice Address - Country:US
Practice Address - Phone:787-246-5944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12189103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical