Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP142934 | TX |
NPI | 1023665791 |
---|---|
Provider Name | Mr. Herbert Visperas Bautista |
First Address | Mckinney, TX 75071-8391 |
Second Address | Dallas, TX 75205-5649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2019 |
Last Update Date | 01/02/2022 |