Provider Demographics
NPI:1417217928
Name:SANTOS F. PACHECO MD INC.
Entity Type:Organization
Organization Name:SANTOS F. PACHECO MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANTOS
Authorized Official - Middle Name:FLAVIO
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-674-1115
Mailing Address - Street 1:10719 S INGLEWOOD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90304-1793
Mailing Address - Country:US
Mailing Address - Phone:310-674-1115
Mailing Address - Fax:310-674-0713
Practice Address - Street 1:10719 S INGLEWOOD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90304-1793
Practice Address - Country:US
Practice Address - Phone:310-674-1115
Practice Address - Fax:310-674-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty