Provider Demographics
NPI:1326266743
Name:DR NESTOR PACHECO
Entity Type:Organization
Organization Name:DR NESTOR PACHECO
Other - Org Name:BAYSHORE PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:361-883-3668
Mailing Address - Street 1:5934 S STAPLES ST
Mailing Address - Street 2:SUITE NUMBER 200
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3859
Mailing Address - Country:US
Mailing Address - Phone:361-883-3668
Mailing Address - Fax:361-883-3695
Practice Address - Street 1:5934 S STAPLES ST
Practice Address - Street 2:SUITE NUMBER 200
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3859
Practice Address - Country:US
Practice Address - Phone:361-883-3668
Practice Address - Fax:361-883-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1242213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T61LMedicare ID - Type Unspecified
TXU55928Medicare UPIN