Provider Demographics
NPI:1356001572
Name:PACHECO, KIMBERLEY SANTANA
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:SANTANA
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 1:12435 KEARNEY CIR
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-4627
Mailing Address - Country:US
Mailing Address - Phone:719-937-3978
Mailing Address - Fax:
Practice Address - Street 1:12435 KEARNEY CIR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-4627
Practice Address - Country:US
Practice Address - Phone:719-937-3978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician