Individual
GINA PACHECO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, CDN
Contact information
Practice address
5959 58TH RD, MASPETH, NY 11378-3211
(917) 470-5458
Mailing address
5959 58TH RD, MASPETH, NY 11378-3211
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
952793
NY
Other
Enumeration date
12/20/2017
Last updated
12/20/2017
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