Provider Demographics
NPI:1942297320
Name:PACHECO, DONALD L (FNP PAC)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:L
Last Name:PACHECO
Suffix:
Gender:M
Credentials:FNP PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 E OAKMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5138
Mailing Address - Country:US
Mailing Address - Phone:559-449-8100
Mailing Address - Fax:559-449-8217
Practice Address - Street 1:6045 N 1ST ST
Practice Address - Street 2:STE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5444
Practice Address - Country:US
Practice Address - Phone:559-449-8100
Practice Address - Fax:559-449-8217
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10474207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP104740Medicare ID - Type Unspecified