Healthcare Provider Details

I. General information

NPI: 1497562029
Provider Name (Legal Business Name): BAZAN ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11872 SHELDON ST
SUN VALLEY CA
91352-1507
US

IV. Provider business mailing address

560 HUDSON ST STE 301
HACKENSACK NJ
07601-6655
US

V. Phone/Fax

Practice location:
  • Phone: 818-689-3687
  • Fax: 212-888-6024
Mailing address:
  • Phone: 201-641-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: HUGO MARQUEZ
Title or Position: CEO
Credential:
Phone: 818-689-3687