Provider Demographics
NPI:1053106096
Name:PACHECO GARRIDO, ALBERTO (MA)
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:PACHECO GARRIDO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8410 W THOMAS RD STE 1388410W
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3329
Mailing Address - Country:US
Mailing Address - Phone:602-907-1301
Mailing Address - Fax:602-907-1301
Practice Address - Street 1:8410 W THOMAS RD STE 138
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3374
Practice Address - Country:US
Practice Address - Phone:602-907-1301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ139169207R00000X, 207Q00000X
AZ20230421123327363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20230421123327OtherARIZONA REGISTRY OF MEDICAL ASSISTANT