Provider Demographics
NPI:1275207292
Name:PACHECO, GENESIS LILLIAN
Entity Type:Individual
Prefix:
First Name:GENESIS
Middle Name:LILLIAN
Last Name:PACHECO
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 1:14276 AZTEC ST
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-5102
Mailing Address - Country:US
Mailing Address - Phone:818-619-5536
Mailing Address - Fax:
Practice Address - Street 1:6355 TOPANGA CANYON BLVD STE 309
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2132
Practice Address - Country:US
Practice Address - Phone:818-650-1907
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician