Provider Demographics
NPI:1992821698
Name:PACHECO, ELVIN JUAN (MD)
Entity type:Individual
Prefix:DR
First Name:ELVIN
Middle Name:JUAN
Last Name:PACHECO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 CALLE CAOBA
Mailing Address - Street 2:URB LOS CAOBOS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-840-0490
Mailing Address - Fax:787-840-0490
Practice Address - Street 1:3301 CALLE CAOBA
Practice Address - Street 2:URB LOS CAOBOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-840-0490
Practice Address - Fax:787-840-0490
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E31215Medicare UPIN
23876Medicare ID - Type Unspecified