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General NPI Number Information
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NPI Number | 1528808292
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Entity Type | Organization
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Legal Business Name | BAUZA FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1601 E FLAMINGO RD STE 18
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City | LAS VEGAS
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State | NV
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Zip | 89119-5244
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Country | US
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Telephone | 725-203-5440
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Fax | 725-204-2524
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Provider Business Mailing Address
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Address Line | 1601 E FLAMINGO RD STE 18
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City | LAS VEGAS
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State | NV
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Zip | 89119-5244
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Country | US
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Telephone | 725-203-5440
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Fax | 725-204-2524
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Authorized Official
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Title or Position | CEO
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Name | MR. LUIS ANGEL RODRIGUEZ BAUZA
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Credential |
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Telephone | 702-810-0066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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