Healthcare Provider Details

I. General information

NPI: 1568927531
Provider Name (Legal Business Name): JOSUE ARREZOLA PACHECO MT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39605 LOS ALAMOS RD STE D
MURRIETA CA
92563-5042
US

IV. Provider business mailing address

39605 LOS ALAMOS RD STE D
MURRIETA CA
92563-5042
US

V. Phone/Fax

Practice location:
  • Phone: 951-387-4629
  • Fax: 951-387-4659
Mailing address:
  • Phone: 951-387-4629
  • Fax: 951-387-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number63903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: