Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1134510522 |
---|---|
Provider Name | Ashley Pacheco |
First Address | Altamonte Springs, FL 32714-7139 |
Second Address | Altamonte Springs, FL 32714-7139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2015 |
Last Update Date | 06/02/2015 |