Provider Demographics
NPI:1699104497
Name:PAZ, JOHN ALBERT
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALBERT
Last Name:PAZ
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 1:5380 SW 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-5307
Mailing Address - Country:US
Mailing Address - Phone:954-918-2647
Mailing Address - Fax:
Practice Address - Street 1:5380 SW 61ST AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-5307
Practice Address - Country:US
Practice Address - Phone:954-918-2647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOAT 13242224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant