Individual
MR. GONZALO BAUTISTA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 SCOTT AND WHITE DR, COLLEGE STATION, TX 77845-6441
(979) 207-0100
(979) 207-2161
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP124090
TX
Other
Enumeration date
04/22/2013
Last updated
12/07/2021
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