MEDICARE: PROF. JULIO C BAUZA MD

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	2080P0202X	Pediatric Cardiology Physician	5128	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5128	OTHER	PR	STATE LICENSE

General Provider Information

NPI Number	:	1336144492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. JULIO C BAUZA MD

Provider Business Mailing Address
First Line	:	55 DORADO BCH E
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-2049
Country	:	US
Telephone Number	:	787-278-3514
Fax Number	:

Provider Business Practice Location Address
First Line	:	SAN JORGE MEDICAL BUILDING
Second Line	:	403
City	:	SAN JUAN
State	:	PR
Zip	:	00912
Country	:	US
Telephone Number	:	787-268-0665
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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