Provider Demographics
NPI:1881830776
Name:PACHON, AMBER LYNN (MD)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:PACHON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LYNN
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4300 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4300 ROSE DR
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886
Practice Address - Country:US
Practice Address - Phone:714-528-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036134569207Q00000X
CAA101464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400180484OtherMEDICARE PTAN (INDIVIDUAL)
IL592050OtherMEDICARE PTAN (CORNERSTONE GROUP)
IL036134569Medicaid