Provider Demographics
NPI:1700025467
Name:PACHECO, SIMONE P (RDH)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:P
Last Name:PACHECO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6129 NAPA AVE
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-2632
Mailing Address - Country:US
Mailing Address - Phone:909-989-0393
Mailing Address - Fax:909-989-0393
Practice Address - Street 1:9560 BASELINE RD STE B
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-6435
Practice Address - Country:US
Practice Address - Phone:909-987-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21607124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist