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General NPI Number Information
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NPI Number | 1003992017
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Entity Type | Individual
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Provider Name | VIDEONA B BAUTISTA M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1524 SE 3RD AVE.
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City | FT. LAUDERDALE
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State | FL
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Zip | 33316-2502
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Country | US
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Telephone | 954-763-6188
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Fax | 951-763-6199
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Provider Business Mailing Address
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Address Line | 1524 SE 3RD AVE
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City | FT LAUDERDALE
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State | FL
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Zip | 33316-2502
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Country | US
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Telephone | 954-763-6188
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Fax | 954-763-6199
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0029452
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License Number State | FL
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