Provider Demographics
NPI:1154977833
Name:PACHECO, GRISELDA (LVN)
Entity type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E HALEY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2576
Mailing Address - Country:US
Mailing Address - Phone:805-708-5491
Mailing Address - Fax:
Practice Address - Street 1:305 CAMINO DEL REMEDIO
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1332
Practice Address - Country:US
Practice Address - Phone:805-465-8199
Practice Address - Fax:805-681-9144
Is Sole Proprietor?:No
Enumeration Date:2019-08-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247057164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse