Provider Demographics
NPI:1235390519
Name:MAZA BODEE, DENNIS F (DPM)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:F
Last Name:MAZA BODEE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5859 AVE ISLA VERDE
Mailing Address - Street 2:CONDOMINIO CORAL BEACH 15
Mailing Address - City:ISLA VERDE
Mailing Address - State:PR
Mailing Address - Zip Code:00979
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5859 AVE ISLA VERDE
Practice Address - Street 2:CONDOMINIO CORAL BEACH 15
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-5701
Practice Address - Country:US
Practice Address - Phone:787-632-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR073213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR48086Medicare UPIN