Provider Demographics
NPI:1689167959
Name:PAEZ, IDEQUIZ (RD, LDN)
Entity Type:Individual
Prefix:
First Name:IDEQUIZ
Middle Name:
Last Name:PAEZ
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5431 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4639
Mailing Address - Country:US
Mailing Address - Phone:954-344-2522
Mailing Address - Fax:954-344-9154
Practice Address - Street 1:5431 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4639
Practice Address - Country:US
Practice Address - Phone:954-344-2522
Practice Address - Fax:954-344-9154
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist