Individual
LICIA PACHECO-LUNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 N WOLFE ST, PHIPPS B100F, BALTIMORE, MD 21287
(410) 955-2353
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
D92522
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D92522
MD LICENSE
MD
Enumeration date
06/26/2019
Last updated
06/02/2022
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