Provider Demographics
NPI:1295141190
Name:BAUTISTA, MESALINA
Entity type:Individual
Prefix:MISS
First Name:MESALINA
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 1:5565 NETHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-2329
Mailing Address - Country:US
Mailing Address - Phone:917-291-6448
Mailing Address - Fax:
Practice Address - Street 1:5565 NETHERLAND AVE
Practice Address - Street 2:APT 6G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2329
Practice Address - Country:US
Practice Address - Phone:917-291-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY622479-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse