Provider Demographics
NPI:1497267462
Name:REYES PACHECO, LLENY MIREYA
Entity Type:Individual
Prefix:
First Name:LLENY
Middle Name:MIREYA
Last Name:REYES 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 1:1029 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3043
Mailing Address - Country:US
Mailing Address - Phone:760-214-5207
Mailing Address - Fax:760-489-4129
Practice Address - Street 1:1029 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3043
Practice Address - Country:US
Practice Address - Phone:760-489-4126
Practice Address - Fax:760-489-4129
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program