Healthcare Provider Details

I. General information

NPI: 1306273297
Provider Name (Legal Business Name): ERNESTO PAZ JR. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PONCE DE LEON BLVD
MIAMI FL
33135-1040
US

IV. Provider business mailing address

45 PONCE DE LEON BLVD
MIAMI FL
33135-1040
US

V. Phone/Fax

Practice location:
  • Phone: 786-444-1337
  • Fax:
Mailing address:
  • Phone: 305-448-4433
  • Fax: 305-441-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN16045
License Number StateFL

VIII. Authorized Official

Name: DR. ERNESTO PAZ JR.
Title or Position: PRESIDENT
Credential:
Phone: 305-448-4433