Individual
EDGAR ALLAN BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6001
Mailing address
3116 N COCHITI AVE, FARMINGTON, NM 87401-2050
(949) 620-7280
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
95330098
CA
Other
Enumeration date
05/13/2024
Last updated
05/13/2024
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