Provider Demographics
NPI:1891742169
Name:BAUTISTA, FRANCISCO M (MD)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:M
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 W 16TH AVE
Mailing Address - Street 2:SUITE 55
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7100
Mailing Address - Country:US
Mailing Address - Phone:305-824-8559
Mailing Address - Fax:305-824-8561
Practice Address - Street 1:4410 W 16TH AVE
Practice Address - Street 2:SUITE 55
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7100
Practice Address - Country:US
Practice Address - Phone:305-824-8559
Practice Address - Fax:305-824-8561
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-73024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3618Medicare ID - Type Unspecified
FLF18613Medicare UPIN