Provider Demographics
NPI:1043841984
Name:AMEZAGA, PAOLA C
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:C
Last Name:AMEZAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3214
Mailing Address - Country:US
Mailing Address - Phone:973-851-8888
Mailing Address - Fax:
Practice Address - Street 1:196 UNION AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3214
Practice Address - Country:US
Practice Address - Phone:973-851-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJA57586166362702343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)