Provider Demographics
NPI:1881914372
Name:SERGIO B PACHECO M.D,P.A
Entity type:Organization
Organization Name:SERGIO B PACHECO M.D,P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:BLANCO
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:915-532-1922
Mailing Address - Street 1:1900 N OREGON ST STE 410
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3348
Mailing Address - Country:US
Mailing Address - Phone:915-532-1922
Mailing Address - Fax:915-242-0200
Practice Address - Street 1:1900 N OREGON ST STE 410
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3348
Practice Address - Country:US
Practice Address - Phone:915-532-1922
Practice Address - Fax:915-242-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3271261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0898025-01Medicaid