Individual
DR. MARIO BAUTISTA
Active
Individual
DR. MARIO BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2004-0547
NM
208000000X
Pediatrics Physician
Primary
35.089012
OH
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
2004-0547
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10016535
LOVELACE HEALTH/SALUD
NM
01
—
201047701
PRESBYTERIAN HEALTH/SALUD
NM
05
—
2711211
—
OH
01
—
885808
AHCCCS
AZ
05
—
99238071
—
NM
01
—
NM009R63
BC/BS
NM
01
—
P00137209
RAILROAD MEDICARE
—
01
—
PROVP11655
MOLINA
NM
Enumeration date
01/05/2006
Last updated
11/25/2020
Update your record
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