MEDICARE: REGLA D RODRIGUEZ BAUZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347E00000X	Transportation Broker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88-4245278	OTHER	FL	TRANSPORTATION

General Provider Information

NPI Number	:	1255048765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGLA D RODRIGUEZ BAUZA

Provider Business Mailing Address
First Line	:	3205 FOXRIDGE CT
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-3681
Country	:	US
Telephone Number	:	561-876-1294
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 FOXRIDGE CT
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-3681
Country	:	US
Telephone Number	:	561-876-1294
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	11/03/2022

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