Provider Demographics
NPI:1104178573
Name:PACIOTTI, STEPHANIE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PACIOTTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27525 ENTERPRISE CIR W
Mailing Address - Street 2:101C
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4884
Mailing Address - Country:US
Mailing Address - Phone:951-676-7693
Mailing Address - Fax:
Practice Address - Street 1:27525 ENTERPRISE CIR W
Practice Address - Street 2:101C
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4884
Practice Address - Country:US
Practice Address - Phone:951-676-7693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist