Provider Demographics
NPI:1386836245
Name:PACHECO, DIANA T
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:T
Last Name:PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:SAMMY
Other - Middle Name:R
Other - Last Name:PACHECO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:809 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:JOURDANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78026-2621
Mailing Address - Country:US
Mailing Address - Phone:830-769-2287
Mailing Address - Fax:
Practice Address - Street 1:809 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-2621
Practice Address - Country:US
Practice Address - Phone:830-769-2287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor