Healthcare Provider Details

I. General information

NPI: 1386210029
Provider Name (Legal Business Name): JOHN BOUZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W SAN BERNARDINO RD
COVINA CA
91723-1515
US

IV. Provider business mailing address

428 CANNON AVE
SAN DIMAS CA
91773-3645
US

V. Phone/Fax

Practice location:
  • Phone: 626-331-7331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A23647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: