Provider Demographics
NPI:1033396676
Name:PACHECO, PARISS NICOLE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:PARISS
Middle Name:NICOLE
Last Name:PACHECO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MRS
Other - First Name:PARISS
Other - Middle Name:NICOLE
Other - Last Name:PACHECO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:762 W CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3505
Mailing Address - Country:US
Mailing Address - Phone:909-599-1227
Mailing Address - Fax:909-971-8052
Practice Address - Street 1:762 W CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3505
Practice Address - Country:US
Practice Address - Phone:909-599-1227
Practice Address - Fax:909-971-8052
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225915164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse