=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942297320
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD L PACHECO FNP PAC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2005
-----------------------------------------------------
Last Update Date | 09/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6045 N 1ST ST STE 103
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93710-5444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-449-8100
-----------------------------------------------------
Fax | 559-449-8217
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2177 E OAKMONT AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93720-5138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-449-8100
-----------------------------------------------------
Fax | 559-449-8217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | PA10474
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------