Provider Demographics
NPI:1952368359
Name:PACHECO, BELLA AURORA (MD)
Entity Type:Individual
Prefix:
First Name:BELLA
Middle Name:AURORA
Last Name:PACHECO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 S MIAMI AVENUE
Mailing Address - Street 2:S602
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133
Mailing Address - Country:US
Mailing Address - Phone:305-854-1861
Mailing Address - Fax:305-854-0178
Practice Address - Street 1:3661 S MIAMI AVENUE
Practice Address - Street 2:S602
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-854-1861
Practice Address - Fax:305-854-0178
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83182208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F81066Medicare UPIN
FL06078Medicare ID - Type Unspecified