Provider Demographics
NPI:1942018809
Name:FERNANDEZ PACHECO GORRIN, DAYANA (CBHCMS)
Entity type:Individual
Prefix:
First Name:DAYANA
Middle Name:
Last Name:FERNANDEZ PACHECO GORRIN
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22711 SILLS LOOP
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-4054
Mailing Address - Country:US
Mailing Address - Phone:813-599-2784
Mailing Address - Fax:
Practice Address - Street 1:1539 DALE MABRY HWY STE 102
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-3008
Practice Address - Country:US
Practice Address - Phone:813-909-7102
Practice Address - Fax:813-909-0199
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0102769171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator