1467483016 NPI number — DR. ESPERANZA PACHECO-JACOME MD

Table of content: DR. ESPERANZA PACHECO-JACOME MD (NPI 1467483016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467483016 NPI number — DR. ESPERANZA PACHECO-JACOME MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACHECO-JACOME
Provider First Name:
ESPERANZA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467483016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 557367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33255-7367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-662-8293
Provider Business Mailing Address Fax Number:
305-667-8689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 SW 62ND AVE
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33155-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-662-8293
Provider Business Practice Location Address Fax Number:
305-667-8689
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085P0229X , with the licence number:  ME 71982 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 257800000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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