Healthcare Provider Details

I. General information

NPI: 1003375155
Provider Name (Legal Business Name): GABRIEL JOSEF BOUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 E FOOTHILL BLVD
SAN DIMAS CA
91773-1208
US

IV. Provider business mailing address

627 E FOOTHILL BLVD
SAN DIMAS CA
91773-1208
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-0881
  • Fax: 909-394-0701
Mailing address:
  • Phone: 909-599-0881
  • Fax: 909-394-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA180495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: