Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | BP 10047110 | TX |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | R0636 | TX |
NPI | 1467890608 |
---|---|
Provider Name | Soraira Pacheco |
First Address | Houston, TX 77030-1501 |
Second Address | Houston, TX 77030-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2013 |
Last Update Date | 17/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BP 10047110 | TEXAS PHYSICIAN IN TRAINING PERMIT (01) | TX |