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NPI Code Detail

MEDICARE: JAQUELINE CERVANTES PACHECO

MEDICARE: JAQUELINE CERVANTES PACHECO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1407494826
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAQUELINE CERVANTES PACHECO
Provider Business Mailing Address
First Line : 12124 CHAMPLAIN ST
Second Line :
City : MORENO VALLEY
State : CA
Zip : 92557-7713
Country : US
Telephone Number : 951-295-3839
Fax Number :
Provider Business Practice Location Address
First Line : 4193 FLAT ROCK DR STE 200
Second Line :
City : RIVERSIDE
State : CA
Zip : 92505-7113
Country : US
Telephone Number : 951-440-6220
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2019
Last Update Date : 11/27/2023

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Directions to “ JAQUELINE CERVANTES PACHECO ” Practice Location

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