Provider Demographics
NPI:1952156515
Name:PAZ, ERICA ANGELINA (PPSP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ANGELINA
Last Name:PAZ
Suffix:
Gender:F
Credentials:PPSP
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:ANGELINA
Other - Last Name:PAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PPSP
Mailing Address - Street 1:4813 LON DALE RD
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-9735
Mailing Address - Country:US
Mailing Address - Phone:209-985-7044
Mailing Address - Fax:
Practice Address - Street 1:1520 YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:ESCALON
Practice Address - State:CA
Practice Address - Zip Code:95320-1753
Practice Address - Country:US
Practice Address - Phone:209-985-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool