Provider Demographics
NPI:1508419763
Name:PACHECO, JESSICA L (CSA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:PACHECO
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 TERRY LN
Mailing Address - Street 2:
Mailing Address - City:LYTLE
Mailing Address - State:TX
Mailing Address - Zip Code:78052-3829
Mailing Address - Country:US
Mailing Address - Phone:210-835-8955
Mailing Address - Fax:830-772-5611
Practice Address - Street 1:170 TERRY LN
Practice Address - Street 2:
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052-3829
Practice Address - Country:US
Practice Address - Phone:210-835-8955
Practice Address - Fax:830-772-5611
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4991OtherCERTIFIED SURGICAL ASSISTANT