Healthcare Provider Details

I. General information

NPI: 1033025002
Provider Name (Legal Business Name): INEZ PARAISO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 OCEAN VIEW AVE
SAN MATEO CA
94401-3462
US

IV. Provider business mailing address

949 OCEAN VIEW AVE
SAN MATEO CA
94401-3462
US

V. Phone/Fax

Practice location:
  • Phone: 650-391-3823
  • Fax:
Mailing address:
  • Phone: 650-312-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number230148416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: