Provider Demographics
NPI:1326322264
Name:PAZ, JUN GERVASIO
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:GERVASIO
Last Name:PAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JUN
Other - Middle Name:BAPTISTA
Other - Last Name:PAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:7000 MICHAEL CANLIS WAY
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231-9781
Mailing Address - Country:US
Mailing Address - Phone:209-468-4550
Mailing Address - Fax:
Practice Address - Street 1:500 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-9693
Practice Address - Country:US
Practice Address - Phone:209-468-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595403163WE0003X
CA20342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency