MEDICARE: MR. ALBERTO J 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	246ZC0007X	Surgical Assistant	17-286	FL

General Provider Information

NPI Number	:	1629967476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALBERTO J PAEZ

Provider Business Mailing Address
First Line	:	9013 VINEYARD LAKE DR
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-1108
Country	:	US
Telephone Number	:	954-529-5475
Fax Number	:

Provider Business Practice Location Address
First Line	:	9013 VINEYARD LAKE DR
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-1108
Country	:	US
Telephone Number	:	954-529-5475
Fax Number	:

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

Provider Enumeration Date	:	06/28/2025
Last Update Date	:	06/28/2025

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