Provider Demographics
NPI:1720243041
Name:PACHECO, LULA J (LMT)
Entity Type:Individual
Prefix:MS
First Name:LULA
Middle Name:J
Last Name:PACHECO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N MAKALEHA PL
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-9453
Mailing Address - Country:US
Mailing Address - Phone:808-572-0512
Mailing Address - Fax:
Practice Address - Street 1:250 N MAKALEHA PL
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9453
Practice Address - Country:US
Practice Address - Phone:808-572-0512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-3960171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor