Provider Demographics
NPI:1114571619
Name:GREG PAEZ JR
Entity Type:Organization
Organization Name:GREG PAEZ JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:559-472-3851
Mailing Address - Street 1:334 SHAW AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-3839
Mailing Address - Country:US
Mailing Address - Phone:559-472-3851
Mailing Address - Fax:
Practice Address - Street 1:334 SHAW AVE STE 115
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3839
Practice Address - Country:US
Practice Address - Phone:559-472-3851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty