Provider Demographics
NPI:1003375155
Name:BOUZ, GABRIEL JOSEF
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:JOSEF
Last Name:BOUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 ZONAL AVE # GNH3900
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0146
Mailing Address - Country:US
Mailing Address - Phone:323-409-7409
Mailing Address - Fax:
Practice Address - Street 1:2025 ZONAL AVE # GNH3900
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0146
Practice Address - Country:US
Practice Address - Phone:323-409-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program