Provider Demographics
NPI:1447667886
Name:GOCO REYES, MARIA PAZ (NP)
Entity type:Individual
Prefix:
First Name:MARIA PAZ
Middle Name:
Last Name:GOCO REYES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-2627
Mailing Address - Country:US
Mailing Address - Phone:562-715-4956
Mailing Address - Fax:
Practice Address - Street 1:1700 WOLLACOTT ST
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2836
Practice Address - Country:US
Practice Address - Phone:562-715-4956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily