MEDICARE: BAUZA NEUROPSYCHIATRY CENTER LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912596685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAUZA NEUROPSYCHIATRY CENTER LLC

Provider Business Mailing Address
First Line	:	1601 E FLAMINGO RD STE 18
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5244
Country	:	US
Telephone Number	:	702-478-9971
Fax Number	:	702-478-9968

Provider Business Practice Location Address
First Line	:	1601 E FLAMINGO RD STE 18
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5244
Country	:	US
Telephone Number	:	702-478-9971
Fax Number	:	702-478-9968

Authorized Official
Title or Position	:	OWNER
Name	:	LUIS ANGEL RODRIGUEZ BAUZA
Credential	:
Telephone Number	:	702-810-0066

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	04/08/2026

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