Provider Demographics
NPI:1982390811
Name:PAEZ, SANDY MARIE
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:MARIE
Last Name:PAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-2127
Mailing Address - Country:US
Mailing Address - Phone:562-441-7629
Mailing Address - Fax:
Practice Address - Street 1:457 KNOLLCREST DR STE 120
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0121
Practice Address - Country:US
Practice Address - Phone:530-392-4399
Practice Address - Fax:530-903-4226
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC12653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health