Provider Demographics
NPI:1417844911
Name:PACHECO, DONNELLE NICHOLE (SUN/CHW)
Entity type:Individual
Prefix:
First Name:DONNELLE
Middle Name:NICHOLE
Last Name:PACHECO
Suffix:
Gender:F
Credentials:SUN/CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 PHELPS AVE
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-9609
Mailing Address - Country:US
Mailing Address - Phone:559-514-0202
Mailing Address - Fax:
Practice Address - Street 1:1191 PHELPS AVE
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-9609
Practice Address - Country:US
Practice Address - Phone:559-514-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker