Provider Demographics
NPI:1609672047
Name:ZAYAS BAZAN, GISELLE VERONICA
Entity type:Individual
Prefix:
First Name:GISELLE
Middle Name:VERONICA
Last Name:ZAYAS BAZAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 NW 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5310
Mailing Address - Country:US
Mailing Address - Phone:786-922-8019
Mailing Address - Fax:
Practice Address - Street 1:528 NW 44TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5310
Practice Address - Country:US
Practice Address - Phone:786-922-8019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician