Provider Demographics
NPI:1487944328
Name:DEPAZ, JORGE O (BA)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:O
Last Name:DEPAZ
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5674 STONERIDGE DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8500
Mailing Address - Country:US
Mailing Address - Phone:925-734-9965
Mailing Address - Fax:925-734-5675
Practice Address - Street 1:5674 STONERIDGE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8500
Practice Address - Country:US
Practice Address - Phone:925-734-9965
Practice Address - Fax:925-734-5675
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker