Provider Demographics
NPI:1902167695
Name:PAEZ, MARCO A (MD)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:A
Last Name:PAEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1901 TOWN AND COUNTRY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3611
Mailing Address - Country:US
Mailing Address - Phone:951-808-6240
Mailing Address - Fax:951-738-9954
Practice Address - Street 1:2250 S MAIN ST
Practice Address - Street 2:STE 205
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2507
Practice Address - Country:US
Practice Address - Phone:951-808-6298
Practice Address - Fax:951-523-7065
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2021-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA154078207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty