Provider Demographics
NPI:1033740790
Name:DE LA PAZ, MARIA PERPETUA (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:PERPETUA
Last Name:DE LA PAZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 E BONANZA RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-2161
Mailing Address - Country:US
Mailing Address - Phone:702-438-1091
Mailing Address - Fax:702-438-0742
Practice Address - Street 1:3602 E BONANZA RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-2161
Practice Address - Country:US
Practice Address - Phone:702-438-1091
Practice Address - Fax:702-438-0742
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV148731835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist