Healthcare Provider Details

I. General information

NPI: 1124978465
Provider Name (Legal Business Name): JASMINE PACHECO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 CAREW ST
SPRINGFIELD MA
01104-2377
US

IV. Provider business mailing address

427 S ROCK RIVER RD
DIAMOND BAR CA
91765-1562
US

V. Phone/Fax

Practice location:
  • Phone: 909-215-0867
  • Fax:
Mailing address:
  • Phone: 909-215-0867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: