Provider Demographics
NPI:1568927531
Name:PACHECO, JOSUE ARREZOLA (MT)
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:ARREZOLA
Last Name:PACHECO
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39605 LOS ALAMOS RD STE D
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5042
Mailing Address - Country:US
Mailing Address - Phone:951-387-4629
Mailing Address - Fax:951-387-4659
Practice Address - Street 1:39605 LOS ALAMOS RD STE D
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-5042
Practice Address - Country:US
Practice Address - Phone:951-387-4629
Practice Address - Fax:951-387-4659
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63903225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist