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General NPI Number Information
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NPI Number | 1235390519
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Entity Type | Individual
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Provider Name | DENNIS F MAZA BODEE DPM
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Gender | Male
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 5859 AVE ISLA VERDE CONDOMINIO CORAL BEACH 15
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City | CAROLINA
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State | PR
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Zip | 00979-5701
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Country | US
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Telephone | 787-632-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 5859 AVE ISLA VERDE CONDOMINIO CORAL BEACH 15
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City | ISLA VERDE
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State | PR
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Zip | 00979
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Country | UM
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 073
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License Number State | PR
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