Provider Demographics
NPI:1568052355
Name:PACHECO, SOPHIE (TRAINEE)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIE
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:TRAINEE
Other - Prefix:MISS
Other - First Name:SOPHIE
Other - Middle Name:
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:628 MONTEZUMA ST
Mailing Address - Street 2:
Mailing Address - City:RIO VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:94571-1622
Mailing Address - Country:US
Mailing Address - Phone:707-374-5003
Mailing Address - Fax:
Practice Address - Street 1:628 MONTEZUMA ST
Practice Address - Street 2:
Practice Address - City:RIO VISTA
Practice Address - State:CA
Practice Address - Zip Code:94571-1622
Practice Address - Country:US
Practice Address - Phone:707-374-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)