Healthcare Provider Details

I. General information

NPI: 1962200857
Provider Name (Legal Business Name): ADRIANA PAEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2484 VISTA WAY STE B
OCEANSIDE CA
92054-5682
US

IV. Provider business mailing address

4935 STONE RIDGE DR
CHINO HILLS CA
91709-7875
US

V. Phone/Fax

Practice location:
  • Phone: 760-439-0334
  • Fax:
Mailing address:
  • Phone: 909-235-8202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: