Healthcare Provider Details

I. General information

NPI: 1437193943
Provider Name (Legal Business Name): LAURA PACEK P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 N RIEDEL ST
YORKTOWN TX
78164-1810
US

IV. Provider business mailing address

508 N RIEDEL ST
YORKTOWN TX
78164-1810
US

V. Phone/Fax

Practice location:
  • Phone: 361-564-9230
  • Fax:
Mailing address:
  • Phone: 361-564-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01213
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: