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General NPI Number Information
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NPI Number | 1912740796
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Entity Type | Individual
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Provider Name | ALISSA MERCEDES PACHECO PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 1272 W MAIN RD
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City | MIDDLETOWN
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State | RI
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Zip | 02842-6405
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Country | US
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Telephone | 401-847-2290
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Fax | 401-849-8446
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Provider Business Mailing Address
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Address Line | 30 TENTH ST APT 3
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City | EAST PROVIDENCE
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State | RI
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Zip | 02914-4814
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Country | US
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Telephone | 774-225-4793
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01720
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License Number State | RI
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