Provider Demographics
NPI:1184883324
Name:DR MANUEL BAUSTISTA,INC,P.S.
Entity type:Organization
Organization Name:DR MANUEL BAUSTISTA,INC,P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-581-6303
Mailing Address - Street 1:PO BOX 39398
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98496-3398
Mailing Address - Country:US
Mailing Address - Phone:253-581-6303
Mailing Address - Fax:253-581-3316
Practice Address - Street 1:9115 BRIDGEPORT WAY SW
Practice Address - Street 2:SUITE #1
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2449
Practice Address - Country:US
Practice Address - Phone:253-581-6303
Practice Address - Fax:253-581-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty