Provider Demographics
NPI:1821020215
Name:PAEZ, VICENTE (AUD)
Entity Type:Individual
Prefix:
First Name:VICENTE
Middle Name:
Last Name:PAEZ
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:951-698-9807
Mailing Address - Fax:951-698-9577
Practice Address - Street 1:41880 KALMIA ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8831
Practice Address - Country:US
Practice Address - Phone:951-698-9807
Practice Address - Fax:951-698-9577
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA3729237700000X
CAAU1709231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAN438ZMedicare PIN