Healthcare Provider Details

I. General information

NPI: 1871377812
Provider Name (Legal Business Name): KARELY LARA PAZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 E BIRCH ST
CALEXICO CA
92231-2374
US

IV. Provider business mailing address

1415 ROSS AVE
EL CENTRO CA
92243-4306
US

V. Phone/Fax

Practice location:
  • Phone: 760-482-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95025163
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95095267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: