Healthcare Provider Details

I. General information

NPI: 1700182060
Provider Name (Legal Business Name): PEDRO GEOVANNY PAZ RD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2781 HERITAGE DR
PASADENA CA
91107-5914
US

IV. Provider business mailing address

2781 HERITAGE DR
PASADENA CA
91107-5914
US

V. Phone/Fax

Practice location:
  • Phone: 951-662-5137
  • Fax: 626-798-8358
Mailing address:
  • Phone: 951-662-5137
  • Fax: 626-798-8358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number914599
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number914599
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number914599
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number914599
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number914599
License Number State
# 6
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number914599
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: