Healthcare Provider Details

I. General information

NPI: 1154028660
Provider Name (Legal Business Name): MARIA TERESA PACHECO HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6544 W THOMAS RD STE 11
PHOENIX AZ
85033-5740
US

IV. Provider business mailing address

6544 W THOMAS RD STE 11
PHOENIX AZ
85033-5740
US

V. Phone/Fax

Practice location:
  • Phone: 602-834-5515
  • Fax: 855-540-2436
Mailing address:
  • Phone: 602-834-5515
  • Fax: 855-540-2436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number80432
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: