1215810569 NPI number — CLINICA DE LINFEDEMA DELIZ BAUZA LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215810569 NPI number — CLINICA DE LINFEDEMA DELIZ BAUZA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICA DE LINFEDEMA DELIZ BAUZA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215810569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 AVENIDA TITO CASTRO
Provider Second Line Business Mailing Address:
SUITE 102 PMB 372
Provider Business Mailing Address City Name:
PONCE
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-232-6510
Provider Business Mailing Address Fax Number:
787-841-7585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
472 EDIFICIO MARVESA
Provider Second Line Business Practice Location Address:
SUITE 108, AVENIDA TITO CASTRO
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-232-6510
Provider Business Practice Location Address Fax Number:
787-841-7585
Provider Enumeration Date:
07/25/2025

Additional Information

Authorized Official

Authorized Official Last Name:
DELIZ
Authorized Official First Name:
ELDRA
Authorized Official Middle Name:
LETICIA
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
787-232-6510

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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