Healthcare Provider Details

I. General information

NPI: 1396423646
Provider Name (Legal Business Name): LUZ FERNANDA REPIZO PAREDES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 VETERANS AVE
BATH NY
14810-0840
US

IV. Provider business mailing address

76 VETERANS AVE
BATH NY
14810-0840
US

V. Phone/Fax

Practice location:
  • Phone: 607-664-4615
  • Fax: 607-664-4647
Mailing address:
  • Phone: 607-664-4615
  • Fax: 607-664-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.117054
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: