1346919453 NPI number — BLANCA ESTRELLA DE PAZ

Table of content: BLANCA ESTRELLA DE PAZ (NPI 1346919453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346919453 NPI number — BLANCA ESTRELLA DE PAZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE PAZ
Provider First Name:
BLANCA
Provider Middle Name:
ESTRELLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346919453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1739 SARAH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINOLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94564-2211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-253-8238
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3075 CITRUS CIR STE 240
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-2667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-256-1100
Provider Business Practice Location Address Fax Number:
925-256-1100
Provider Enumeration Date:
09/10/2021

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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