Provider Demographics
NPI:1164951661
Name:PACHECO, GREGORIO SR
Entity Type:Individual
Prefix:
First Name:GREGORIO
Middle Name:
Last Name:PACHECO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 FLINT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2806
Mailing Address - Country:US
Mailing Address - Phone:582-285-1026
Mailing Address - Fax:
Practice Address - Street 1:204 FLINT ST APT 1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2806
Practice Address - Country:US
Practice Address - Phone:585-285-1026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122363688344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi