Healthcare Provider Details

I. General information

NPI: 1225997745
Provider Name (Legal Business Name): SANTIAGO PACHECO MA
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: SUZITA PACHECO MA

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MOUNTAIN RD NW
ALBUQUERQUE NM
87104-1359
US

IV. Provider business mailing address

61 S UNION ST APT 406
ROCHESTER NY
14607-1962
US

V. Phone/Fax

Practice location:
  • Phone: 505-557-4656
  • Fax:
Mailing address:
  • Phone: 505-792-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: