Provider Demographics
NPI:1497562029
Name:BAZAN ENTERPRISES LLC
Entity type:Organization
Organization Name:BAZAN ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-689-3687
Mailing Address - Street 1:560 HUDSON ST STE 301
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6655
Mailing Address - Country:US
Mailing Address - Phone:201-641-2125
Mailing Address - Fax:
Practice Address - Street 1:11872 SHELDON ST
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-1507
Practice Address - Country:US
Practice Address - Phone:818-689-3687
Practice Address - Fax:212-888-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty