Provider Demographics
NPI:1760528103
Name:AVERRUZ-GENIE, PAULA
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:
Last Name:AVERRUZ-GENIE
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 1:1414 NW 107TH AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:280 17TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-4124
Practice Address - Country:US
Practice Address - Phone:510-238-5020
Practice Address - Fax:510-261-3584
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health