MEDICARE: DR. JULIUS DELANTAR BAUTISTA DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	P122239	NY

General Provider Information

NPI Number	:	1548947625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIUS DELANTAR BAUTISTA DPM

Provider Business Mailing Address
First Line	:	9244 213TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1123
Country	:	US
Telephone Number	:	516-312-8377
Fax Number	:

Provider Business Practice Location Address
First Line	:	9244 213TH ST
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1123
Country	:	US
Telephone Number	:	516-312-8377
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	05/17/2026

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