Provider Demographics
NPI:1619742889
Name:DE PAZ, MOSES OMAR
Entity Type:Individual
Prefix:
First Name:MOSES
Middle Name:OMAR
Last Name:DE 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 1:3877 12TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3578
Mailing Address - Country:US
Mailing Address - Phone:951-742-5044
Mailing Address - Fax:
Practice Address - Street 1:36637 BAY HILL DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-8021
Practice Address - Country:US
Practice Address - Phone:951-261-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician