Individual
TRICIA BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 WATER ST FL 18, NEW YORK, NY 10041-0055
(510) 708-0921
Mailing address
55 WATER ST FL 18, NEW YORK, NY 10041-0055
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
330293
NY
207QA0401X
Addiction Medicine (Family Medicine) Physician
A180675
CA
Other
Enumeration date
03/25/2020
Last updated
08/18/2024
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