Healthcare Provider Details

I. General information

NPI: 1346646734
Provider Name (Legal Business Name): LESLIE PACHECO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 HOFFMAN DR NE
ALBUQUERQUE NM
87110-5526
US

IV. Provider business mailing address

1722 HOFFMAN DR NE
ALBUQUERQUE NM
87110-5526
US

V. Phone/Fax

Practice location:
  • Phone: 505-795-0402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: