Provider Demographics
NPI:1093586950
Name:PAZ, ASHLEY (PT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:PAZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8605 SANTA MONICA BLVD PMB 968365
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4109
Mailing Address - Country:US
Mailing Address - Phone:909-565-7012
Mailing Address - Fax:
Practice Address - Street 1:11650 MISSION PARK DR STE 114
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-9010
Practice Address - Country:US
Practice Address - Phone:909-565-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-10
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA3053502081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine