Healthcare Provider Details

I. General information

NPI: 1023087145
Provider Name (Legal Business Name): CARLOS EMMANUEL DELA PAZ ZAENS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 TEXAN TRAIL SUITE 101
CORPUS CHRISTI TX
78411
US

IV. Provider business mailing address

PO BOX 6022
CORPUS CHRISTI TX
78466-6022
US

V. Phone/Fax

Practice location:
  • Phone: 361-814-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number372202
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: