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General NPI Number Information
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NPI Number | 1417217928
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Entity Type | Organization
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Legal Business Name | SANTOS F. PACHECO MD INC.
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Dates
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Enumeration Date | 05/18/2012
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 10719 S INGLEWOOD AVE SUITE A
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City | INGLEWOOD
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State | CA
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Zip | 90304-1793
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Country | US
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Telephone | 310-674-1115
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Fax | 310-674-0713
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Provider Business Mailing Address
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Address Line | 10719 S INGLEWOOD AVE SUITE A
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City | INGLEWOOD
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State | CA
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Zip | 90304-1793
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Country | US
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Telephone | 310-674-1115
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Fax | 310-674-0713
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. SANTOS FLAVIO PACHECO
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Credential | M.D.
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Telephone | 310-674-1115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A54292
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License Number State | CA
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