Provider Demographics
NPI:1972896603
Name:BAUTA, LOURDES CRISTINA
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:CRISTINA
Last Name:BAUTA
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 1:9545 SW 24TH ST
Mailing Address - Street 2:APT. B-316
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8075
Mailing Address - Country:US
Mailing Address - Phone:786-269-9254
Mailing Address - Fax:
Practice Address - Street 1:9545 SW 24TH ST
Practice Address - Street 2:APT. B-316
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-8075
Practice Address - Country:US
Practice Address - Phone:786-269-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program