Provider Demographics
NPI:1992431456
Name:PACHECO TORRES, ILEANA ENID
Entity type:Individual
Prefix:
First Name:ILEANA
Middle Name:ENID
Last Name:PACHECO TORRES
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:URB MARIOLGA
Mailing Address - Street 2:I18 CALLE SAN ANTONIO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-6419
Mailing Address - Country:US
Mailing Address - Phone:787-604-4474
Mailing Address - Fax:
Practice Address - Street 1:URB MARIOLGA
Practice Address - Street 2:I18 CALLE SAN ANTONIO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6419
Practice Address - Country:US
Practice Address - Phone:787-604-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR156371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical