Healthcare Provider Details

I. General information

NPI: 1326294943
Provider Name (Legal Business Name): MRS. CARMEN PATRICIA PACHECO-CUEBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WOODSIDE AVE BLDG W-3
SAN FRANCISCO CA
94127-1221
US

IV. Provider business mailing address

509 W 10TH ST
ANTIOCH CA
94509-1653
US

V. Phone/Fax

Practice location:
  • Phone: 415-753-7784
  • Fax:
Mailing address:
  • Phone: 925-381-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: