Provider Demographics
NPI:1720360571
Name:PAZERA, JOHN F (MS-CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:F
Last Name:PAZERA
Suffix:
Gender:M
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12222 WOODSIDE AVE STE A
Mailing Address - Street 2:105
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-3000
Mailing Address - Country:US
Mailing Address - Phone:858-774-1397
Mailing Address - Fax:
Practice Address - Street 1:1331 W BASELINE RD
Practice Address - Street 2:208
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5876
Practice Address - Country:US
Practice Address - Phone:858-774-1397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist