Provider Demographics
NPI:1689355513
Name:PACHASA, CARLIE (RDN, LD)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:
Last Name:PACHASA
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:CARLIE
Other - Middle Name:
Other - Last Name:MOSTEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3751 STANNARD DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4713
Mailing Address - Country:US
Mailing Address - Phone:419-973-7417
Mailing Address - Fax:
Practice Address - Street 1:3751 STANNARD DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4713
Practice Address - Country:US
Practice Address - Phone:419-973-7417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09696133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered