Healthcare Provider Details

I. General information

NPI: 1063219707
Provider Name (Legal Business Name): DON PACHECO PPS, M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CHALLENGER DR
ALAMEDA CA
94501-1037
US

IV. Provider business mailing address

1925 STUART ST
BERKELEY CA
94703-2214
US

V. Phone/Fax

Practice location:
  • Phone: 510-337-7000
  • Fax:
Mailing address:
  • Phone: 510-219-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number150015669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: