Healthcare Provider Details

I. General information

NPI: 1871090456
Provider Name (Legal Business Name): MARISSA ANN DE LA PAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 N 2ND ST
CABOT AR
72023-2209
US

IV. Provider business mailing address

2900 HAWKINS DR
SEARCY AR
72143-4802
US

V. Phone/Fax

Practice location:
  • Phone: 501-843-5757
  • Fax: 501-843-5700
Mailing address:
  • Phone: 501-843-5757
  • Fax: 501-843-5700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number313288
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-17929
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: