Basic Information
| Provider Information | |||||||||
| NPI: | 1881622843 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PACHOREK | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 S RAYMOND AVE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262566010 | ||||||||
| FaxNumber: | 6262566070 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 S RAYMOND AVE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267954223 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 10/22/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G61061 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110063420 | 01 | CA | RAILROAD MEDICARE | OTHER |