Provider Demographics
NPI:1528808292
Name:BAUZA FAMILY MEDICINE
Entity type:Organization
Organization Name:BAUZA FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:RODRIGUEZ BAUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-810-0066
Mailing Address - Street 1:1601 E FLAMINGO RD STE 18
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5244
Mailing Address - Country:US
Mailing Address - Phone:725-203-5440
Mailing Address - Fax:725-204-2524
Practice Address - Street 1:1601 E FLAMINGO RD STE 18
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5244
Practice Address - Country:US
Practice Address - Phone:725-203-5440
Practice Address - Fax:725-204-2524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty