Healthcare Provider Details

I. General information

NPI: 1336690387
Provider Name (Legal Business Name): STEVEN BAZAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MERCED ST
SAN LEANDRO CA
94577-4201
US

IV. Provider business mailing address

42561 HAMILTON WAY
FREMONT CA
94538-5534
US

V. Phone/Fax

Practice location:
  • Phone: 510-454-2070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: