Provider Demographics
NPI:1700317922
Name:PACHECO, ERIN (QMHA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:KEALA
Other - Middle Name:
Other - Last Name:PACHECO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QMHA
Mailing Address - Street 1:3435 W CRAIG RD
Mailing Address - Street 2:STE D
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-5115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3435 W CRAIG RD
Practice Address - Street 2:STE D
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-5115
Practice Address - Country:US
Practice Address - Phone:786-326-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner