Organization
THE AMISTAD CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM BAUTISTA AMISTAD JR. FNP-BC (PROVIDER)
(480) 773-8569
Entity
Organization
Contact information
Practice address
100 E 24TH ST STE 3A, YUMA, AZ 85364-8619
(480) 773-8569
Mailing address
100 E 24TH ST STE 3A, YUMA, AZ 85364-8619
(928) 750-6410
(928) 750-6433
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
AP9557
AZ
261QP2300X
Primary Care Clinic/Center
Primary
AP9557
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205215
—
AZ
Enumeration date
08/27/2018
Last updated
02/24/2025
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