Individual
ANA L PACHECO CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4700 HOEN AVE, SANTA ROSA, CA 95405-7824
(707) 526-3360
(707) 526-0554
Mailing address
4700 HOEN AVE, SANTA ROSA, CA 95405-7824
(707) 526-3360
(707) 526-0554
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G62400
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G624000
—
CA
Enumeration date
06/09/2006
Last updated
01/04/2012
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