Provider Demographics
NPI:1598173072
Name:PACHECO-WALKER, MIRNA
Entity Type:Individual
Prefix:
First Name:MIRNA
Middle Name:
Last Name:PACHECO-WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 731691
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95173-1691
Mailing Address - Country:US
Mailing Address - Phone:408-726-7209
Mailing Address - Fax:
Practice Address - Street 1:544 VALLEY WAY
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-4106
Practice Address - Country:US
Practice Address - Phone:408-726-7209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health