Provider Demographics
NPI:1518172048
Name:BAZAVILVAZO, ANITA (TECHINICAN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:BAZAVILVAZO
Suffix:
Gender:F
Credentials:TECHINICAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1922
Mailing Address - Country:US
Mailing Address - Phone:213-483-9930
Mailing Address - Fax:213-483-8730
Practice Address - Street 1:2100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1922
Practice Address - Country:US
Practice Address - Phone:213-483-9930
Practice Address - Fax:213-483-8730
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other