Healthcare Provider Details

I. General information

NPI: 1275885709
Provider Name (Legal Business Name): CARLOS PAZ MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7025 N CHESTNUT AVE STE. 105
FRESNO CA
93720-0351
US

IV. Provider business mailing address

7025 N CHESTNUT AVE STE. 105
FRESNO CA
93720-0351
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-3376
  • Fax: 559-233-6647
Mailing address:
  • Phone: 559-233-3376
  • Fax: 559-233-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA 121126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: