Provider Demographics
NPI:1205508678
Name:BAZAN, NESLA Z
Entity type:Individual
Prefix:
First Name:NESLA
Middle Name:Z
Last Name:BAZAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14354 SW 134TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8375
Mailing Address - Country:US
Mailing Address - Phone:305-975-0489
Mailing Address - Fax:
Practice Address - Street 1:14354 SW 134TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8375
Practice Address - Country:US
Practice Address - Phone:305-975-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician