1316110141 NPI number — DR. ANGEL ENRIQUE PACHECO PH.D., C.PSYCH.

Table of content: DR. ANGEL ENRIQUE PACHECO PH.D., C.PSYCH. (NPI 1316110141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316110141 NPI number — DR. ANGEL ENRIQUE PACHECO PH.D., C.PSYCH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PACHECO
Provider First Name:
ANGEL
Provider Middle Name:
ENRIQUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., C.PSYCH.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316110141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
47 INDER HEIGHTS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRAMPTON
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
L6Z 3N5
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
647-701-6715
Provider Business Mailing Address Fax Number:
905-970-1333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2680 MATHESON BOULEVARD EAST, SUITE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSISSAUGA
Provider Business Practice Location Address State Name:
ONTARIO
Provider Business Practice Location Address Postal Code:
L4W 0A5
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
647-701-6715
Provider Business Practice Location Address Fax Number:
905-970-1333
Provider Enumeration Date:
04/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PSY 5395 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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