Provider Demographics
NPI:1336838903
Name:PACHECO, NESTOR ISAI
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:ISAI
Last Name:PACHECO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3057
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93006-3057
Mailing Address - Country:US
Mailing Address - Phone:805-515-6259
Mailing Address - Fax:
Practice Address - Street 1:2021 SPERRY AVE STE 44
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7417
Practice Address - Country:US
Practice Address - Phone:805-515-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1142641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical