=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821020215
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICENTE PAEZ AU.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 12/02/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41880 KALMIA ST SUITE 120
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92562-8831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-698-9807
-----------------------------------------------------
Fax | 951-698-9577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 406153
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30384-1876
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-698-9807
-----------------------------------------------------
Fax | 951-698-9577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | HA3729
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | AU1709
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------