Provider Demographics
NPI:1154911709
Name:PAIZ, GUILLERMO JOSE
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:JOSE
Last Name:PAIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 MONROE CT
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-1486
Mailing Address - Country:US
Mailing Address - Phone:626-297-4416
Mailing Address - Fax:
Practice Address - Street 1:2121 E HARMONY RD UNIT 310
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3403
Practice Address - Country:US
Practice Address - Phone:970-689-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1330146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist