Healthcare Provider Details

I. General information

NPI: 1932755568
Provider Name (Legal Business Name): IRENE PACHECO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 ALAMEDA AVE
EL PASO TX
79905-2705
US

IV. Provider business mailing address

333 N SANTA ROSA
SAN ANTONIO TX
78207-3108
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-5700
  • Fax: 915-215-8872
Mailing address:
  • Phone: 210-704-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAP143599
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP143599
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: