Provider Demographics
NPI:1851265193
Name:PACHECO, VANESSA (MT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31682 RAILROAD CANYON RD STE 9
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-9481
Mailing Address - Country:US
Mailing Address - Phone:951-483-4454
Mailing Address - Fax:
Practice Address - Street 1:31682 RAILROAD CANYON RD STE 9
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-9481
Practice Address - Country:US
Practice Address - Phone:951-483-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75687225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist