Provider Demographics
NPI:1235780693
Name:PAZ, IVAN M (NL, ND)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:M
Last Name:PAZ
Suffix:
Gender:M
Credentials:NL, ND
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 VILLA NEVAREZ PROFESSIONAL BUILDING, ST. 2
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-5345
Mailing Address - Country:US
Mailing Address - Phone:787-282-7979
Mailing Address - Fax:787-763-4481
Practice Address - Street 1:120 VILLA NEVAREZ PROFESSIONAL BUILDING , ST. 2
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-5345
Practice Address - Country:US
Practice Address - Phone:787-282-7979
Practice Address - Fax:787-763-4481
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000096175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath