Provider Demographics
NPI:1568887669
Name:PACHECO, MARIO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:PACHECO
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11012 LOCH AVON DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-1530
Mailing Address - Country:US
Mailing Address - Phone:562-774-5351
Mailing Address - Fax:
Practice Address - Street 1:11012 LOCH AVON DR
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-1530
Practice Address - Country:US
Practice Address - Phone:562-774-5351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA570465163W00000X
CA95000401363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse