Provider Demographics
NPI:1699446104
Name:PACHECO, GENEVIEVE AMORA
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:AMORA
Last Name:PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19123 COTTONWOOD DR APT 1417
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8678
Mailing Address - Country:US
Mailing Address - Phone:323-272-1725
Mailing Address - Fax:
Practice Address - Street 1:4760 OAKLAND ST STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-2732
Practice Address - Country:US
Practice Address - Phone:720-452-0335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician