Individual
EVANGELINA BAUSTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1314 LAKE ST, FORT WORTH, TX 76102-4581
(903) 532-1400
Mailing address
824 WHITE ROCK ST, SAGINAW, TX 76179-3430
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
119696
TX
Other
Enumeration date
08/07/2018
Last updated
08/07/2018
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