Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25MA09862800 | NJ |
N | 208600000X | Surgeon | 25MA09862800 | NJ |
Y | 2086S0102X | Surgical Critical Care | 25MA09862800 | NJ |
NPI | 1043479595 |
---|---|
Provider Name | Gustavo Bauza |
First Address | New Brunswick, NJ 08901-4100 |
Second Address | New Brunswick, NJ 08901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 23/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
249589 | MASSACHUSETTS MEDICAL LICENSE (01) | MA |
25MA09862800 | NEW JERSEY MEDICAL LICENSE (01) | NJ |