Healthcare Provider Details

I. General information

NPI: 1720184526
Provider Name (Legal Business Name): DEBORAH YVONNE PACHECO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 WOODBURN RD
ANNANDALE VA
22003-1202
US

IV. Provider business mailing address

3340 WOODBURN RD
ANNANDALE VA
22003-1202
US

V. Phone/Fax

Practice location:
  • Phone: 703-207-7815
  • Fax: 703-280-9518
Mailing address:
  • Phone: 703-207-7815
  • Fax: 703-280-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101043611
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: