Provider Demographics
NPI:1114186285
Name:BAUZA CORDERO, ALEJANDRO SR (CONSEJERO PROFECIONA)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:BAUZA CORDERO
Suffix:SR
Gender:M
Credentials:CONSEJERO PROFECIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2615
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-2615
Mailing Address - Country:US
Mailing Address - Phone:787-785-6690
Mailing Address - Fax:787-780-3103
Practice Address - Street 1:CALLE MAGA FRENTE AL HOSPITAL DE PSICIATRIA
Practice Address - Street 2:CENTROMEDICO DRUG COURT ASSMCA
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00250
Practice Address - Country:US
Practice Address - Phone:787-641-0774
Practice Address - Fax:787-641-2759
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2162101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)