Provider Demographics
NPI:1114542594
Name:PACHECO- SILVA, MAYTE
Entity Type:Individual
Prefix:
First Name:MAYTE
Middle Name:
Last Name:PACHECO- SILVA
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 1:1995 CHARLE ST APT B
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-6904
Mailing Address - Country:US
Mailing Address - Phone:949-220-4859
Mailing Address - Fax:
Practice Address - Street 1:106 DISCOVERY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3131
Practice Address - Country:US
Practice Address - Phone:949-203-8872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician