Provider Demographics
NPI:1609104470
Name:PAEZ, RUTH (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:PAEZ
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4722
Mailing Address - Country:US
Mailing Address - Phone:626-458-8401
Mailing Address - Fax:626-458-5606
Practice Address - Street 1:941 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4722
Practice Address - Country:US
Practice Address - Phone:626-458-8401
Practice Address - Fax:626-458-5606
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-06
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20662363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical