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Individual

JUAN M BAUTISTA SR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3063 W CHAPMAN AVE APT 2128, ORANGE, CA 92868-1741
(714) 398-3400
Mailing address
3063 W CHAPMAN AVE APT 2128, ORANGE, CA 92868-1741
(714) 398-3400

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
C6202844
CA

Other

Enumeration date
09/09/2021
Last updated
09/09/2021
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