=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114555372
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHALIE DE PAZ MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2020
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 SW 129TH AVE STE 405
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027-1718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-228-8180
-----------------------------------------------------
Fax | 954-228-8183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 SW 129TH AVE STE 405
-----------------------------------------------------
City | PEMBROKE PINES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027-1718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-228-8180
-----------------------------------------------------
Fax | 954-228-8183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | ME160114
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------