Healthcare Provider Details

I. General information

NPI: 1578673968
Provider Name (Legal Business Name): MARIA LOURDES DE GUZMAN BAUTISTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE
BRONX NY
10457-2545
US

IV. Provider business mailing address

4422 3RD AVE
BRONX NY
10457-2545
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-9331
  • Fax: 718-960-3792
Mailing address:
  • Phone: 718-960-9331
  • Fax: 718-960-3792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number245271
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: