Healthcare Provider Details

I. General information

NPI: 1497190425
Provider Name (Legal Business Name): MR. CALIXTO PACHECO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E SHAW AVE STE 150
FRESNO CA
93710-8109
US

IV. Provider business mailing address

1630 E SHAW AVE STE 150
FRESNO CA
93710-8109
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-8550
  • Fax: 916-779-2558
Mailing address:
  • Phone: 559-248-8550
  • Fax: 916-779-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: