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General NPI Number Information
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NPI Number | 1902514854
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Entity Type | Organization
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Legal Business Name | BAZAN THERAPEUTICS, LLC
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Dates
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Enumeration Date | 11/09/2022
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 3012 E MAIN AVE STE A&B
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City | ALTON
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State | TX
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Zip | 78573-0907
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Country | US
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Telephone | 956-600-8461
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Fax | 956-306-3501
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Provider Business Mailing Address
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Address Line | 3012 E MAIN AVE STE A&B
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City | ALTON
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State | TX
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Zip | 78573-0907
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Country | US
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Telephone | 956-600-8461
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Fax | 956-306-3501
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Authorized Official
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Title or Position | OWNER
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Name | NOE BAZAN
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Credential |
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Telephone | 956-600-8462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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