Provider Demographics
NPI:1376314773
Name:BASTIDA, FELIPITA
Entity Type:Individual
Prefix:
First Name:FELIPITA
Middle Name:
Last Name:BASTIDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-4433
Mailing Address - Country:US
Mailing Address - Phone:361-358-1650
Mailing Address - Fax:361-358-8058
Practice Address - Street 1:403 N MONROE ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-4433
Practice Address - Country:US
Practice Address - Phone:361-358-1650
Practice Address - Fax:361-358-8058
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146124261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care