Provider Demographics
NPI:1710290226
Name:PAVEZ, GERALDINE (ACNP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:PAVEZ
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 UCLA MEDICAL PLAZA, SUITE 660
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095
Mailing Address - Country:US
Mailing Address - Phone:310-206-2235
Mailing Address - Fax:310-825-2092
Practice Address - Street 1:100 UCLA MEDICAL PLAZA, SUITE 660
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-206-2235
Practice Address - Fax:310-825-2092
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP19294363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care