Individual
RICARDO ANDRE DECLET-BAUZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2330 UTAH AVE STE 200, EL SEGUNDO, CA 90245-4817
(281) 766-0959
Mailing address
1116 W CARMEN ST UNIT 319, TAMPA, FL 33606-1368
(787) 608-2600
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01097300A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
166292
FL
Other
Enumeration date
05/04/2018
Last updated
04/10/2026
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