Provider Demographics
NPI:1518576859
Name:PACHECO, SIMONE LARANJO
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:LARANJO
Last Name:PACHECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 TROSSACHS BLVD SE UNIT 1206
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-5920
Mailing Address - Country:US
Mailing Address - Phone:425-999-9456
Mailing Address - Fax:
Practice Address - Street 1:1855 TROSSACHS BLVD SE UNIT 1206
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-5920
Practice Address - Country:US
Practice Address - Phone:425-999-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPACHESL328DFOtherDRIVERS LICENSE