Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | 2021-00810 | NC |
N | 2080P0207X | Pediatric Hematology-Oncologist | MD444093 | PA |
NPI | 1124289079 |
---|---|
Provider Name | Felipe S Bautista Otanez |
First Address | Charlotte, NC 28260-0447 |
Second Address | Charlotte, NC 28204-2467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 11/06/2021 |