Provider Demographics
NPI:1114747771
Name:PACHECO, BREANNA MARLENE (CMPSS)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARLENE
Last Name:PACHECO
Suffix:
Gender:F
Credentials:CMPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25331 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-2029
Mailing Address - Country:US
Mailing Address - Phone:951-400-8042
Mailing Address - Fax:
Practice Address - Street 1:2220 GIRARD ST
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5301
Practice Address - Country:US
Practice Address - Phone:951-683-6596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-SGREPF175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist