Healthcare Provider Details

I. General information

NPI: 1346072634
Provider Name (Legal Business Name): SHARON BAZAN AS, RRT, RPFT.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 416
LONG BEACH CA
90801-0416
US

IV. Provider business mailing address

PO BOX 416
LONG BEACH CA
90801-0416
US

V. Phone/Fax

Practice location:
  • Phone: 626-833-8741
  • Fax:
Mailing address:
  • Phone: 626-833-8741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number35217
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2279E1000X
TaxonomyEducational Registered Respiratory Therapist
License Number35217
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2279P1004X
TaxonomyPulmonary Diagnostics Registered Respiratory Therapist
License Number35217
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number35217
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code2279P1006X
TaxonomyPulmonary Function Technologist Registered Respiratory Therapist
License Number35217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: