Provider Demographics
NPI:1518559129
Name:PACHECO, JOSHUA ALBERTO (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALBERTO
Last Name:PACHECO
Suffix:
Gender:M
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43863 12TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4700
Mailing Address - Country:US
Mailing Address - Phone:310-909-6160
Mailing Address - Fax:
Practice Address - Street 1:2615 PACIFIC COAST HWY STE 300
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2227
Practice Address - Country:US
Practice Address - Phone:310-406-1500
Practice Address - Fax:310-406-1531
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-47258103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst