MEDICARE: MERCEDES L PACHECO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1518787472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCEDES L PACHECO

Provider Business Mailing Address
First Line	:	3745 S GRAND AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-4332
Country	:	US
Telephone Number	:	213-479-7606
Fax Number	:

Provider Business Practice Location Address
First Line	:	15268 GOLDEN SANDS ST
Second Line	:
City	:	LAKE ELSINORE
State	:	CA
Zip	:	92530-7309
Country	:	US
Telephone Number	:	213-479-7606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/15/2024

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