Basic Information
| Provider Information | |||||||||
| NPI: | 1730570243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAEZ | ||||||||
| FirstName: | CARMINA-LOU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 703 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900174810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139970419 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1245 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 703 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900174810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139770419 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2015 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 95000962 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.