Provider Demographics
NPI:1629655006
Name:BAUTISTA, JESSICA MONTALBAN (DO, MS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MONTALBAN
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:DO, MS
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:19641 E PARKER SQUARE DR STE A
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7397
Mailing Address - Country:US
Mailing Address - Phone:303-840-3800
Mailing Address - Fax:303-840-8442
Practice Address - Street 1:19641 E PARKER SQUARE DR STE A
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7397
Practice Address - Country:US
Practice Address - Phone:303-840-3800
Practice Address - Fax:303-840-8442
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0069284207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program