Provider Demographics
NPI:1366997868
Name:BAUZA CARDIOVASCULAR SPECIALIST LLC
Entity type:Organization
Organization Name:BAUZA CARDIOVASCULAR SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAZQUEZ-BAUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-212-6235
Mailing Address - Street 1:3213 S 24TH ST
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108-1832
Mailing Address - Country:US
Mailing Address - Phone:402-916-4130
Mailing Address - Fax:402-916-4140
Practice Address - Street 1:3213 S 24TH ST
Practice Address - Street 2:SUITE 101B
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108-1832
Practice Address - Country:US
Practice Address - Phone:402-916-4130
Practice Address - Fax:402-916-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE19950261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty