Basic Information
| Provider Information | |||||||||
| NPI: | 1700852993 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PACHECO | ||||||||
| FirstName: | EVA | ||||||||
| MiddleName: | CHRISTINA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4421 IRVING BLVD NW STE C | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871145919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058972291 | ||||||||
| FaxNumber: | 5058973085 | ||||||||
| Practice Location | |||||||||
| Address1: | 4421 IRVING BVLD NW, STE C | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871021710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5053414148 | ||||||||
| FaxNumber: | 5053459914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 12/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 94-116 | NM | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 13513 | 05 | NM | MEDICAID |