Provider Demographics
NPI:1760471395
Name:PACHECO, PETER DAVID (RPH, PA-C)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:DAVID
Last Name:PACHECO
Suffix:
Gender:M
Credentials:RPH, PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15 CALLE ALFREDO
Mailing Address - Street 2:
Mailing Address - City:ALGODONES
Mailing Address - State:NM
Mailing Address - Zip Code:87001-8025
Mailing Address - Country:US
Mailing Address - Phone:505-235-8031
Mailing Address - Fax:
Practice Address - Street 1:4700 JEFFERSON ST NE
Practice Address - Street 2:SUITE 700
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2136
Practice Address - Country:US
Practice Address - Phone:505-881-5080
Practice Address - Fax:505-872-2306
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2001PA02363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant