Individual
MR. IVAN AUDBERTO BAUZA HENRIQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
1056 AVE MUNOZ RIVERA, SUITE 608 FIRST FEDERAL BUILDING, RIO PIEDRAS, PR 00927-5015
(787) 661-0174
(787) 858-0218
Mailing address
PO BOX 10817, SAN JUAN, PR 00922
(787) 661-0174
(787) 858-0218
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
1886
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3087
APS
PR
01
—
580437
FHCHS OF PR
PR
Enumeration date
08/09/2007
Last updated
08/20/2008
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