Individual
ALEXANDER BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4101 NE DIVISION ST, GRESHAM, OR 97030-4617
(503) 666-6575
Mailing address
4101 NE DIVISION ST, GRESHAM, OR 97030-4617
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
200640866RN
OR
Other
Enumeration date
08/21/2024
Last updated
08/21/2024
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