Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | NP95011450 | CA |
NPI | 1124681887 |
---|---|
Provider Name | Victoria L Bazanos |
First Address | Redlands, CA 92373-7253 |
Second Address | Loma Linda, CA 92354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2019 |
Last Update Date | 18/04/2019 |