Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 15510 | PR |
NPI | 1043200843 |
---|---|
Provider Name | Dr. Luis A Pacheco Oliveras |
First Address | Sabana Grande, PR 00683-1523 |
Second Address | Sabana Grande, PUERTO RICO 00637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 16/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I24146 | (02) | PR |