Healthcare Provider Details

I. General information

NPI: 1306095880
Provider Name (Legal Business Name): VICTOR MICHAEL PACHECO PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 12/09/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DR MHSDS R-2
VACAVILLE CA
95687
US

IV. Provider business mailing address

1600 CALIFORNIA DR MHSDS R-2
VACAVILLE CA
95687
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-6841
  • Fax: 707-453-7015
Mailing address:
  • Phone: 707-448-6841
  • Fax: 707-453-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 13768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: