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Individual

WILBUR DOMENDEN BAUTISTA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1901 S UNION AVE BLDG B STE 2011, TACOMA, WA 98405
(253) 272-0324
(253) 272-0490
Mailing address
4253 E ROOSEVELT AVE, TACOMA, WA 98404-4659
(808) 387-7618

Taxonomy

Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
Primary

Other

Enumeration date
08/13/2018
Last updated
08/13/2018
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