Individual
MARIO CASEY PACHECO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10803 SE CHERRY BLOSSOM DRIVE, PORTLAND, OR 97216-3107
(503) 261-7200
(503) 261-7249
Mailing address
10803 SE CHERRY BLOSSOM DRIVE, PORTLAND, OR 97216-3107
(503) 261-7200
(503) 261-7249
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD218889
OR
207Q00000X
Family Medicine Physician
U6045
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500837045
—
OR
Enumeration date
03/29/2021
Last updated
08/21/2024
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