Provider Demographics
NPI:1629194287
Name:PAZ, GLORIA MARIA
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:MARIA
Last Name:PAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 COMMODORE DR
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2304
Mailing Address - Country:US
Mailing Address - Phone:650-583-1260
Mailing Address - Fax:650-872-3626
Practice Address - Street 1:1290 COMMODORE DR
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2304
Practice Address - Country:US
Practice Address - Phone:650-583-1260
Practice Address - Fax:650-872-3626
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36754106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist