Provider Demographics
NPI:1679948228
Name:DE LA PAZ, MARIA ISABEL (CPL)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ISABEL
Last Name:DE LA PAZ
Suffix:
Gender:F
Credentials:CPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 CALLE SIERRA MORENA
Mailing Address - Street 2:PMB 173
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5636
Mailing Address - Country:US
Mailing Address - Phone:787-904-0084
Mailing Address - Fax:
Practice Address - Street 1:267 CALLE SIERRA MORENA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5574
Practice Address - Country:US
Practice Address - Phone:787-904-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCPL4185101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81575OtherDATE OF BIRTH