Provider Demographics
NPI:1538562046
Name:MARAVILLAS, PACIFICO
Entity type:Individual
Prefix:
First Name:PACIFICO
Middle Name:
Last Name:MARAVILLAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E NOLANA LOOP
Mailing Address - Street 2:STE. F
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-9684
Mailing Address - Country:US
Mailing Address - Phone:956-702-5199
Mailing Address - Fax:956-702-5207
Practice Address - Street 1:300 E NOLANA LOOP
Practice Address - Street 2:STE. F
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-9684
Practice Address - Country:US
Practice Address - Phone:956-702-5199
Practice Address - Fax:956-702-5207
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician