Provider Demographics
NPI:1831447184
Name:PACHECO, NEPTHALI MUNOZ
Entity type:Individual
Prefix:
First Name:NEPTHALI
Middle Name:MUNOZ
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 1:1023 BURNS WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-2634
Mailing Address - Country:US
Mailing Address - Phone:209-938-8956
Mailing Address - Fax:
Practice Address - Street 1:1023 BURNS WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2634
Practice Address - Country:US
Practice Address - Phone:209-938-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13-00111146343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)