=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285432948
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVIDENCE BASED WELLNESS MEDICINE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2025
-----------------------------------------------------
Last Update Date | 03/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 54 TALNUCK DR
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14612-6008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-820-6093
-----------------------------------------------------
Fax | 585-361-5514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 54 TALNUCK DR
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14612-6008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-820-6093
-----------------------------------------------------
Fax | 585-361-5514
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | DR. GEORGE PAZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 585-820-6093
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------