Provider Demographics
NPI:1356819239
Name:BAUTISTA, ALEJANDRO ANDRES (CRNA)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:ANDRES
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-4405
Mailing Address - Country:US
Mailing Address - Phone:860-679-2000
Mailing Address - Fax:
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1956
Practice Address - Country:US
Practice Address - Phone:860-679-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2024-03-02
Deactivation Date:2018-11-16
Deactivation Code:
Reactivation Date:2018-11-28
Provider Licenses
StateLicense IDTaxonomies
CT7987367500000X
CT134050163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine