Healthcare Provider Details

I. General information

NPI: 1356468698
Provider Name (Legal Business Name): FRANCISCO D BAUTISTA-MENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W FLAGLER ST
MIAMI FL
33135-1425
US

IV. Provider business mailing address

6101 BLUE LAGOON DR 4TH FLOOR
MIAMI FL
33126-2055
US

V. Phone/Fax

Practice location:
  • Phone: 305-631-0660
  • Fax:
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number171183
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: