Provider Demographics
NPI:1417418096
Name:PAZ, ANTHONY EDWARD
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:EDWARD
Last Name:PAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 OLD TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1220
Mailing Address - Country:US
Mailing Address - Phone:805-342-8490
Mailing Address - Fax:
Practice Address - Street 1:421 OLD TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1220
Practice Address - Country:US
Practice Address - Phone:805-342-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health