Provider Demographics
NPI:1023164134
Name:BAUTISTA, CATALINA
Entity type:Individual
Prefix:MS
First Name:CATALINA
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7228 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1724
Mailing Address - Country:US
Mailing Address - Phone:215-248-6070
Mailing Address - Fax:215-248-2410
Practice Address - Street 1:7228 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19119-1724
Practice Address - Country:US
Practice Address - Phone:215-248-6070
Practice Address - Fax:215-248-2410
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician