MEDICARE: DR. DOV PAZ PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY21534	CA

General Provider Information

NPI Number	:	1750570149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOV PAZ PHD

Provider Business Mailing Address
First Line	:	3730 MAY ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3608
Country	:	US
Telephone Number	:	310-398-4518
Fax Number	:	801-951-6592

Provider Business Practice Location Address
First Line	:	3730 MAY ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3608
Country	:	US
Telephone Number	:	310-398-4518
Fax Number	:	801-951-6592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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