Provider Demographics
NPI:1598368490
Name:PAZ, ERNESTO JOSE (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:JOSE
Last Name:PAZ
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 CACTUS FLOWER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-7303
Mailing Address - Country:US
Mailing Address - Phone:760-799-9767
Mailing Address - Fax:
Practice Address - Street 1:63 CACTUS FLOWER
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-7303
Practice Address - Country:US
Practice Address - Phone:760-799-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115411106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist