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General NPI Number Information
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NPI Number | 1730633462
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Entity Type | Individual
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Provider Name | ROBERT A PACHECO DPT
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Gender | Male
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 2701 W ALAMEDA AVE SUITE 206
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City | BURBANK
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State | CA
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Zip | 91505-4402
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Country | US
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Telephone | 818-841-3936
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Fax | 818-841-5974
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Provider Business Mailing Address
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Address Line | PO BOX 100 PMB 700
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City | MAMMOTH LAKES
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State | CA
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Zip | 93546
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Country | US
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Telephone | 760-924-4148
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PT291664
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License Number State | CA
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