Provider Demographics
NPI:1427320910
Name:PAZ, SOFIA ESTELA
Entity type:Individual
Prefix:MRS
First Name:SOFIA
Middle Name:ESTELA
Last Name:PAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SOFIA
Other - Middle Name:ESTELA
Other - Last Name:LANDOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IMF 71229
Mailing Address - Street 1:3100 ACTIS RD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-5911
Mailing Address - Country:US
Mailing Address - Phone:661-831-1609
Mailing Address - Fax:661-832-7565
Practice Address - Street 1:3100 ACTIS RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-831-1906
Practice Address - Fax:661-832-7565
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 71229106H00000X
390200000X
CA107019101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program