Provider Demographics
NPI:1548202542
Name:BAUTISTA, REMIGIO LOPEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:REMIGIO
Middle Name:LOPEZ
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18181 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6949
Mailing Address - Country:US
Mailing Address - Phone:440-816-6414
Mailing Address - Fax:440-816-6421
Practice Address - Street 1:17951 JEFFERSON PARK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-8439
Practice Address - Country:US
Practice Address - Phone:440-816-6414
Practice Address - Fax:440-816-6421
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35100004208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0377579Medicaid
OH0377579Medicaid
OHBA0408723Medicare ID - Type Unspecified