Provider Demographics
NPI:1639356504
Name:ILUMINADA PACHECO GARCIA
Entity type:Organization
Organization Name:ILUMINADA PACHECO GARCIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILUMINADA
Authorized Official - Middle Name:
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:787-804-1844
Mailing Address - Street 1:9 ANGEL GREGORIO MARTINEZ
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637
Mailing Address - Country:US
Mailing Address - Phone:787-804-1844
Mailing Address - Fax:787-804-1844
Practice Address - Street 1:9 ANGEL GREGORIO MARTINEZ
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-804-1844
Practice Address - Fax:787-804-1844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ILUMINADA PACHECO GARCIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-23
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2829291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030158Medicare PIN