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General NPI Number Information
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NPI Number | 1649990615
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Entity Type | Individual
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Provider Name | MARISA ANN PACHECO CSFA
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Gender | Female
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 520 MADISON OAK DR
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3913
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Country | US
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Telephone | 210-297-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 2026 SKULL VALLEY DR
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City | SAN ANTONIO
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State | TX
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Zip | 78245-2812
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Country | US
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Telephone | 210-685-6418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 206422
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License Number State | TX
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