Provider Demographics
NPI:1821020090
Name:PACHECO, LEOPOLDO ARTURO (CRNA)
Entity Type:Individual
Prefix:
First Name:LEOPOLDO
Middle Name:ARTURO
Last Name:PACHECO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 HEDGEWAY CIR
Mailing Address - Street 2:P.O. BOX 450241
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-4660
Mailing Address - Country:US
Mailing Address - Phone:972-496-6449
Mailing Address - Fax:972-496-6406
Practice Address - Street 1:2402 HEDGEWAY CIR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-4660
Practice Address - Country:US
Practice Address - Phone:972-496-6449
Practice Address - Fax:972-496-6406
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54117367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered