Provider Demographics
NPI:1902175292
Name:DE LA PAZ MEDICAL AND WEIGHT LOSS PA
Entity Type:Organization
Organization Name:DE LA PAZ MEDICAL AND WEIGHT LOSS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YIRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DE LA PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-920-5599
Mailing Address - Street 1:PO BOX 820897
Mailing Address - Street 2:
Mailing Address - City:SOUTH FLORIDA
Mailing Address - State:FL
Mailing Address - Zip Code:33082-0897
Mailing Address - Country:US
Mailing Address - Phone:888-920-5599
Mailing Address - Fax:888-921-9449
Practice Address - Street 1:12550 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1713
Practice Address - Country:US
Practice Address - Phone:888-920-5599
Practice Address - Fax:888-921-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89466261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care