Individual
ANNELISE GLORI PACHECO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10930 TERRA VISTA PKWY, APT128, RANCHO CUCAMONGA, CA 91730-6329
(951) 463-1602
Mailing address
10930 TERRA VISTA PKWY, APT128, RANCHO CUCAMONGA, CA 91730-6329
(951) 463-1602
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
85602
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85602
—
CA
Enumeration date
04/18/2017
Last updated
04/18/2017
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