| Pacheco-medina Dental Corporation | |
|
2323 De La Vina St. Suite 207 Santa Barbara CA 93105-3880 | |
| (805) 687-1106 | |
| (805) 687-5886 |
| Full Name | Pacheco-medina Dental Corporation |
|---|---|
| Speciality | Dentist |
| Location | 2323 De La Vina St., Santa Barbara, California |
| Authorized Official Name and Position | Leticia Medina (SECRETARY/OWNER) |
| Authorized Official Contact | 8056871106 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacheco-medina Dental Corporation 2323 De La Vina St. Suite 207 Santa Barbara CA 93105-3880 Ph: (805) 687-1106 | Pacheco-medina Dental Corporation 2323 De La Vina St. Suite 207 Santa Barbara CA 93105-3880 Ph: (805) 687-1106 |
| NPI Number | 1750609400 |
|---|---|
| Provider Enumeration Date | 05/05/2010 |
| Last Update Date | 05/05/2010 |
| Medicare PECOS PAC ID | 3476982042 |
|---|---|
| Medicare Enrollment ID | O20200402000518 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750609400 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 39448 (California) | Primary |
| Provider Name | Leticia Medina |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1760606677 PECOS PAC ID: 2365871944 Enrollment ID: I20200603002029 |
| Provider Name | Roberto Pacheco |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1902020977 PECOS PAC ID: 6901235589 Enrollment ID: I20200603002257 |
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