Provider Demographics
NPI:1144654153
Name:PACHECO, RAYMOND DRETTI (LPN/CRT)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:DRETTI
Last Name:PACHECO
Suffix:
Gender:M
Credentials:LPN/CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 N CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401
Mailing Address - Country:US
Mailing Address - Phone:850-348-2077
Mailing Address - Fax:
Practice Address - Street 1:509 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401
Practice Address - Country:US
Practice Address - Phone:850-348-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5145767164W00000X
FLTT 15573227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified