Individual
PATRICK PEREZ BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9118 VANDERVEER ST, QUEENS VILLAGE, NY 11428-1242
(718) 581-9682
Mailing address
9118 VANDERVEER ST, QUEENS VILLAGE, NY 11428-1242
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
0282451
NY
Other
Enumeration date
03/14/2007
Last updated
01/17/2013
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