Provider Demographics
NPI:1083796635
Name:BAUTISTA, LEYNA T X (MD)
Entity Type:Individual
Prefix:DR
First Name:LEYNA
Middle Name:T
Last Name:BAUTISTA
Suffix:X
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73D WINTHROP AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3716
Mailing Address - Country:US
Mailing Address - Phone:978-686-3017
Mailing Address - Fax:978-685-4280
Practice Address - Street 1:73D WINTHROP AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3716
Practice Address - Country:US
Practice Address - Phone:978-686-3017
Practice Address - Fax:978-685-4280
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT048486207Q00000X
MA257311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine