Healthcare Provider Details

I. General information

NPI: 1710290226
Provider Name (Legal Business Name): GERALDINE PAVEZ ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UCLA MEDICAL PLAZA, SUITE 660
LOS ANGELES CA
90095
US

IV. Provider business mailing address

100 UCLA MEDICAL PLAZA, SUITE 660
LOS ANGELES CA
90095
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-2235
  • Fax: 310-825-2092
Mailing address:
  • Phone: 310-206-2235
  • Fax: 310-825-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP19294
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: