Individual ProviderLicia Pacheco-LunaRadiologyAllopathic & Osteopathic PhysiciansPractice Address600 N Wolfe St, Phipps B100f, Baltimore, MD 21287(410) 955-2353PECOS EnrollmentBased on the most recent information from CMS, provider Licia Pacheco-Luna is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1619538014Provider TypeIndividualFull NamePacheco-Luna, LiciaCredentialMDGenderFemaleSole ProprietorNoEnumeration Date6/26/2019Last Updated6/2/2022Contact InformationPractice LocationPractice Address600 N Wolfe St, Phipps B100f, Baltimore, MD 21287Phone(410) 955-2353FaxUnlisted FaxMailing LocationMailing Address6201 Greenleigh Ave, Middle River, MD 21220-2004PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicenseD92522MarylandCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerIDD92522DescriptionOtherIssuerMD LICENSEMaryland