Basic Information
| Provider Information | |||||||||
| NPI: | 1205082799 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAZ-LUM | ||||||||
| FirstName: | MARIA THERESA | ||||||||
| MiddleName: | LIWAG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PAZ | ||||||||
| OtherFirstName: | MARIA THERESA | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4000 CIVIC CENTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949034171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154923333 | ||||||||
| FaxNumber: | 4154923425 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 CIVIC CENTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949034171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154923333 | ||||||||
| FaxNumber: | 4154923425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2008 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A109693 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.