Provider Demographics
NPI: | 1891105185 |
---|---|
Name: | IRIS MARIA PACHLER |
Entity type: | Organization |
Organization Name: | IRIS MARIA PACHLER |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CLINICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | IRIS |
Authorized Official - Middle Name: | MARIA |
Authorized Official - Last Name: | PACHLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD |
Authorized Official - Phone: | 530-417-5824 |
Mailing Address - Street 1: | 7949 CALIFORNIA AVE |
Mailing Address - Street 2: | SUITE 10 |
Mailing Address - City: | FAIR OAKS |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95628-7156 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 530-417-5824 |
Mailing Address - Fax: | 916-404-0457 |
Practice Address - Street 1: | 7949 CALIFORNIA AVE |
Practice Address - Street 2: | SUITE 10 |
Practice Address - City: | FAIR OAKS |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95628-7156 |
Practice Address - Country: | US |
Practice Address - Phone: | 530-417-5824 |
Practice Address - Fax: | 916-404-0457 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-05-07 |
Last Update Date: | 2014-06-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | PSY26304 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |