Provider Demographics
NPI:1851554562
Name:PAZ, GENELYN IMBAT (PA)
Entity Type:Individual
Prefix:
First Name:GENELYN
Middle Name:IMBAT
Last Name:PAZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C CO 302D BSB
Mailing Address - Street 2:UNIT # 15609
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96224-5609
Mailing Address - Country:US
Mailing Address - Phone:315-730-4336
Mailing Address - Fax:
Practice Address - Street 1:CAMP CASEY USAHC
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96224
Practice Address - Country:US
Practice Address - Phone:315-730-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1081049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant