Healthcare Provider Details

I. General information

NPI: 1376263004
Provider Name (Legal Business Name): ABELARDO PACHECO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HUETAMO #120, FRACC EL PEDREGAL
TECATE BAJA CALIFORNIA
21460
MX

IV. Provider business mailing address

PO BOX 1061
TECATE CA
91980-1061
US

V. Phone/Fax

Practice location:
  • Phone: 619-272-9021
  • Fax: 619-329-9663
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4429628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: