Individual
MR. GUADALUPE V BAZAN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SUDPT
Contact information
Practice address
609 W LOGAN AVE, YAKIMA, WA 98902-5553
(509) 367-1674
Mailing address
609 W LOGAN AVE, YAKIMA, WA 98902-5553
(509) 367-1674
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
60914407
WA
Other
Enumeration date
06/17/2020
Last updated
06/17/2020
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