Individual
CARLOS G. BAUTISTA SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1643 N 20TH AVE, MELROSE PARK, IL 60160-1903
(872) 239-0010
(844) 803-7433
Mailing address
1643 N 20TH AVE, MELROSE PARK, IL 60160-1903
(872) 239-0010
(844) 803-7433
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
07/23/2019
Last updated
07/23/2019
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