Provider Demographics
NPI:1154617835
Name:PIANA-PACHECO, PEACHY MAE TADIFA (MD)
Entity type:Individual
Prefix:DR
First Name:PEACHY MAE
Middle Name:TADIFA
Last Name:PIANA-PACHECO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:633 GOV CARLOS CAMACHO ROAD SUITE 210
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-0834
Mailing Address - Country:US
Mailing Address - Phone:671-649-1001
Mailing Address - Fax:
Practice Address - Street 1:633 GOV CARLOS CAMACHO ROAD SUITE 210
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-649-1001
Practice Address - Fax:671-649-1002
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1996322085R0202X
CAA1396822085R0202X
GUM-21462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology