Provider Demographics
NPI:1376634808
Name:BAUTISTA, MANUEL FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:FRANCISCO
Last Name:BAUTISTA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 39398
Mailing Address - Street 2:DR MANUEL F BAUTISTA INC PS
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98439-0398
Mailing Address - Country:US
Mailing Address - Phone:253-581-6303
Mailing Address - Fax:283-581-3316
Practice Address - Street 1:9115 BRIDGEPORT WAY SW
Practice Address - Street 2:STE 1
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2499
Practice Address - Country:US
Practice Address - Phone:253-581-6303
Practice Address - Fax:253-581-3316
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
WA000265992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1071117Medicaid
WA1071117Medicaid
F32418Medicare UPIN