Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | TRN16621 | FL |
N | 2080P0203X | Pediatric Critical Care Doctor | ME113838 | FL |
Y | 2080P0203X | Pediatric Critical Care Doctor | R0230705 | TX |
NPI | 1235427998 |
---|---|
Provider Name | Dr. Peter Michael Bautista Mangubat |
First Address | Corpus Christi, TX 78411-1721 |
Second Address | Corpus Christi, TX 78411-1721 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2011 |
Last Update Date | 06/10/2016 |