Active NPI
Ruben Pacheco, OPAC
- Medical Physician Assistant
- Rockwall, TX
National Provider Identifier
1255441630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 929
- Practice address
- 6617 Heritage Pkwy
Suite 110
Rockwall, TX 75087-8750 - Phone
- (972) 475-8914
- Fax
- (972) 412-8601
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 929 | TX | Primary |
Addresses
Primary practice location
6617 Heritage Pkwy
Suite 110
Rockwall, TX 75087-8750
Mailing address
810 N Goliad St
Rockwall, TX 75087-2718
Phone (972) 475-8914
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 929 | TX | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255441630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "810 N GOLIAD ST",
"city": "ROCKWALL",
"state": "TX",
"postal_code": "750872718",
"telephone_number": "972-475-8914",
"fax_number": "972-412-8601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6617 HERITAGE PKWY",
"address_2": "SUITE 110",
"city": "ROCKWALL",
"state": "TX",
"postal_code": "750878750",
"telephone_number": "972-475-8914",
"fax_number": "972-412-8601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACHECO",
"first_name": "RUBEN",
"credential": "OPAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "929",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockwall, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.