Provider Demographics
NPI:1063499135
Name:BAUTISTA, RODOLFO ESTRERA (MD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:ESTRERA
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3110 WILLIAM STYRON SQ N
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2691
Mailing Address - Country:US
Mailing Address - Phone:757-314-7656
Mailing Address - Fax:757-314-7906
Practice Address - Street 1:MCDONALD ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:JEFFERSON AVE BUILDING 576
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-5548
Practice Address - Country:US
Practice Address - Phone:757-314-7656
Practice Address - Fax:757-314-7906
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101031891208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics