Healthcare Provider Details

I. General information

NPI: 1700277464
Provider Name (Legal Business Name): LUIS ANGEL RODRIGUEZ BAUZA BSN-RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FLAMINGO RD STE 18
LAS VEGAS NV
89119-5244
US

IV. Provider business mailing address

1601 E FLAMINGO RD STE 18
LAS VEGAS NV
89119-5244
US

V. Phone/Fax

Practice location:
  • Phone: 702-810-0066
  • Fax:
Mailing address:
  • Phone: 702-478-9971
  • Fax: 702-478-9968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number874320
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number874320
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number874320
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number920278
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number874320
License Number StateNV
# 6
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number874320
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: