Provider Demographics
NPI:1699264424
Name:PACHECO, MAGDA LILIANA
Entity type:Individual
Prefix:DR
First Name:MAGDA
Middle Name:LILIANA
Last Name:PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5848 STRADA CAPRI WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3274
Mailing Address - Country:US
Mailing Address - Phone:201-336-2948
Mailing Address - Fax:
Practice Address - Street 1:5848 STRADA CAPRI WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3274
Practice Address - Country:US
Practice Address - Phone:201-336-2948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415938122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist