1962485243 NPI number — DR. JEANETTE PAZ KUIZON MD

Table of content: DR. JEANETTE PAZ KUIZON MD (NPI 1962485243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962485243 NPI number — DR. JEANETTE PAZ KUIZON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUIZON
Provider First Name:
JEANETTE
Provider Middle Name:
PAZ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAZ
Provider Other First Name:
JEANETTE
Provider Other Middle Name:
CUBE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962485243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
737 W CHILDS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCED
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95340-6805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-383-1848
Provider Business Mailing Address Fax Number:
209-384-3966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
797 W CHILDS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERCED
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95340-6805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-383-5871
Provider Business Practice Location Address Fax Number:
209-383-1402
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A79785 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A797850 . This is a "BLUE SHIELD OF CA PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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