Provider Demographics
NPI:1215232525
Name:PACHECO, MARIANA (PHYSICAL THERAPY ASS)
Entity type:Individual
Prefix:MRS
First Name:MARIANA
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY ASS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8433 OTIS ST APT C
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2595
Mailing Address - Country:US
Mailing Address - Phone:323-202-0597
Mailing Address - Fax:
Practice Address - Street 1:8433 OTIS ST APT C
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2595
Practice Address - Country:US
Practice Address - Phone:323-202-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT2458225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant