Provider Demographics
NPI:1588167175
Name:PAEZ, KAREN SOCORRO (RDHAP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SOCORRO
Last Name:PAEZ
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16546 CADENCE LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1489
Mailing Address - Country:US
Mailing Address - Phone:909-615-8737
Mailing Address - Fax:
Practice Address - Street 1:16546 CADENCE LN
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1489
Practice Address - Country:US
Practice Address - Phone:909-615-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA679124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist