Healthcare Provider Details

I. General information

NPI: 1568936433
Provider Name (Legal Business Name): DIANA M PACHECO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 AVENIDA DE LAS CAMPANAS
SANTA FE NM
87507-5369
US

IV. Provider business mailing address

68 COYOTE TRL
SANTA FE NM
87508-8631
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-1808
  • Fax:
Mailing address:
  • Phone: 505-629-6334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberM09231
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: