Provider Demographics
NPI:1851593214
Name:BAUZO, IVETTE M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:M
Last Name:BAUZO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 CALLE CESAR GONZALEZ
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2637
Mailing Address - Country:US
Mailing Address - Phone:787-250-1515
Mailing Address - Fax:787-753-0708
Practice Address - Street 1:479 CALLE CESAR GONZALEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2637
Practice Address - Country:US
Practice Address - Phone:787-250-1515
Practice Address - Fax:787-753-0708
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist