=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477438331
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIEGO ALDO PAZ HURTADO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2025
-----------------------------------------------------
Last Update Date | 08/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2150 STOCKTON BLVD
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95817-1337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-875-1109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1407 BORDEAU DR
-----------------------------------------------------
City | LODI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95242-4506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-210-7366
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 167G00000X
-----------------------------------------------------
Taxonomy Name | Licensed Psychiatric Technician
-----------------------------------------------------
License Number | 42365
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------