| Doctor Name: | MR. ISMAEL BAZAN |
| NPI Number: | 1073738456 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CDPT |
| License Number: | RC00046735 |
| Business Practice Address: | 720 W Court St Suite 8 Nueva Esperanza Pasco, WA - 99301 |
| Business Phone Number: | 5095456506 |
| Business Fax Number: | 5095460520 |
| Mailing Address: | Po Box 1323, PASCO |
| State: | WA |
| Postal Code: | 99301 |
| Phone Number: | 5095472204 |
| Fax Number: | 5095428836 |
| NPI Enumeration Date: | 04/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | RC00046735 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |