Healthcare Provider Details

I. General information

NPI: 1154573772
Provider Name (Legal Business Name): JOEL DE LA PAZ, D.O., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81812 DOCTOR CARREON BLVD SUITE F
INDIO CA
92201-5594
US

IV. Provider business mailing address

PO BOX 4259
CERRITOS CA
90703-4259
US

V. Phone/Fax

Practice location:
  • Phone: 760-775-2225
  • Fax:
Mailing address:
  • Phone: 562-407-2080
  • Fax: 562-407-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOEL DE LA PAZ
Title or Position: PRESIDENT
Credential: D.O.
Phone: 562-407-2080