Provider Demographics
NPI:1447804372
Name:PACHECO, JONATHAN T
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:T
Last Name:PACHECO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 PASEO TOSAMAR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8177
Mailing Address - Country:US
Mailing Address - Phone:317-385-3007
Mailing Address - Fax:
Practice Address - Street 1:1055 E COLORADO BLVD STE 560
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2380
Practice Address - Country:US
Practice Address - Phone:818-241-6780
Practice Address - Fax:818-242-6850
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician