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Individual
VICENTE BAUTISTA
Active
Individual
VICENTE BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA 04805
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA04805
PHYSICIAN ASSISTANTS
TX
Enumeration date
08/09/2006
Last updated
07/15/2019
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