Healthcare Provider Details

I. General information

NPI: 1114571619
Provider Name (Legal Business Name): GREG PAEZ JR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 SHAW AVE STE 115
CLOVIS CA
93612-3839
US

IV. Provider business mailing address

334 SHAW AVE STE 115
CLOVIS CA
93612-3839
US

V. Phone/Fax

Practice location:
  • Phone: 559-472-3851
  • Fax:
Mailing address:
  • Phone: 559-472-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. GREG PAEZ JR.
Title or Position: OWNER
Credential:
Phone: 559-472-3851