Provider Demographics
NPI:1952069262
Name:BAUTISTA, VALERIA MARIA (BT)
Entity Type:Individual
Prefix:MISS
First Name:VALERIA
Middle Name:MARIA
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:BT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 TAWNY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:KINDRED
Mailing Address - State:FL
Mailing Address - Zip Code:34744-6192
Mailing Address - Country:US
Mailing Address - Phone:321-402-1064
Mailing Address - Fax:
Practice Address - Street 1:3831 W VINE ST STE 60
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4650
Practice Address - Country:US
Practice Address - Phone:407-559-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician