=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699340588
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FERNEY ALBERTO PAEZ OLMOS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2021
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 MAPLE AVE STE 15
-----------------------------------------------------
City | HONESDALE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18431-1460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-253-8219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4801 ALBERTA AVE.
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-215-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD486210
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------