Individual
JUAN ALBERTO BASTIDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
1434 SIR THOPAS TRL, AUSTIN, TX 78748-3741
(512) 424-9282
Mailing address
1434 SIR THOPAS TRL, AUSTIN, TX 78748-3741
(512) 424-9282
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
332407
TX
Other
Enumeration date
11/28/2016
Last updated
11/28/2016
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