Healthcare Provider Details

I. General information

NPI: 1326322264
Provider Name (Legal Business Name): JUN GERVASIO PAZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JUN BAPTISTA PAZ NP

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W HOSPITAL RD
FRENCH CAMP CA
95231-9693
US

IV. Provider business mailing address

7000 MICHAEL CANLIS WAY
FRENCH CAMP CA
95231-9781
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6000
  • Fax:
Mailing address:
  • Phone: 209-468-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20342
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number595403
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: