Individual
JORGE BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
132 GLYNBROOK ST N, KEIZER, OR 97303-5796
(971) 227-9808
Mailing address
312 MONMOUTH INDEPENDENCE HWY, MONMOUTH, OR 97361-1730
(971) 283-3664
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/24/2021
Last updated
08/02/2021
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