Provider Demographics
NPI:1801044573
Name:PACHECO, AMBER M (LMT)
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:M
Last Name:PACHECO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 MISSION AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4906
Mailing Address - Country:US
Mailing Address - Phone:505-489-4940
Mailing Address - Fax:
Practice Address - Street 1:518 MISSION AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4906
Practice Address - Country:US
Practice Address - Phone:505-489-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3810172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist