Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 0101048334 | VA |
NPI | 1235197195 |
---|---|
Provider Name | Dr. Harold C Bautista |
First Address | Fredericksburg, VA 22401-3000 |
Second Address | Fredericksburg, VA 22401-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6908057 | (05) | VA |
F58050 | (02) | VA |
P00008506 | MEDICARE RAILROAD (01) | VA |