Provider Demographics
NPI:1700277464
Name:RODRIGUEZ BAUZA, LUIS ANGEL (BSN-RN)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ANGEL
Last Name:RODRIGUEZ BAUZA
Suffix:
Gender:M
Credentials:BSN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4268 ROANRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2113
Mailing Address - Country:US
Mailing Address - Phone:702-810-0066
Mailing Address - Fax:
Practice Address - Street 1:1601 E FLAMINGO RD STE 18
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5244
Practice Address - Country:US
Practice Address - Phone:702-810-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY920278163WG0000X
NV874320163WN0800X, 163WP0808X, 163W00000X, 163WG0000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician