MEDICARE: MRS. ELIZABETH PAEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	21678	AZ

General Provider Information

NPI Number	:	1336903764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH PAEZ

Provider Business Mailing Address
First Line	:	1812 THISTLE RD
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-7741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 THISTLE RD
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86004-7741
Country	:	US
Telephone Number	:	928-814-9692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2024
Last Update Date	:	02/07/2024

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