Provider Demographics
NPI:1639442783
Name:GARCIA-BAUTA, WILFREDO D (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:D
Last Name:GARCIA-BAUTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18081 BISCAYNE BLVD
Mailing Address - Street 2:4N #1103
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2526
Mailing Address - Country:US
Mailing Address - Phone:201-708-5375
Mailing Address - Fax:305-623-7772
Practice Address - Street 1:1405 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-5732
Practice Address - Country:US
Practice Address - Phone:786-248-3588
Practice Address - Fax:305-623-7772
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR015455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine