Provider Demographics
NPI:1225491129
Name:PAEZ, JOSE (SLP)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:PAEZ
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 NW 21ST AVE
Mailing Address - Street 2:101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-5645
Mailing Address - Country:US
Mailing Address - Phone:305-910-4935
Mailing Address - Fax:
Practice Address - Street 1:7400 NW 21ST AVE
Practice Address - Street 2:101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-5645
Practice Address - Country:US
Practice Address - Phone:305-910-4935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ 7497235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist