Provider Demographics
NPI:1902670557
Name:PACHANO, SOFIA NAZARETH (CFSA)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:NAZARETH
Last Name:PACHANO
Suffix:
Gender:F
Credentials:CFSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 NAPOLEON CT APT A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5822
Mailing Address - Country:US
Mailing Address - Phone:813-447-7914
Mailing Address - Fax:
Practice Address - Street 1:5615 NAPOLEON CT APT A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5822
Practice Address - Country:US
Practice Address - Phone:813-447-7914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23-700246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant