Healthcare Provider Details

I. General information

NPI: 1437210432
Provider Name (Legal Business Name): DR. ROSAURA PACHECO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 E ALLUVIAL AVE STE #102
FRESNO CA
93720-3857
US

IV. Provider business mailing address

1885 E ALLUVIAL AVE STE #102
FRESNO CA
93720
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-9690
  • Fax: 559-298-9655
Mailing address:
  • Phone: 559-298-9690
  • Fax: 559-298-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: