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General NPI Number Information
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NPI Number | 1295076081
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Entity Type | Individual
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Provider Name | AMBER BAUTISTA
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Gender | Female
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 1870 S BOULDER AVE
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City | TULSA
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State | OK
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Zip | 74119-5234
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Country | US
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Telephone | 918-585-1213
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Fax | 918-743-8845
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Provider Business Mailing Address
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Address Line | 3732 S INDIANAPOLIS AVE 203
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City | TULSA
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State | OK
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Zip | 74135-2285
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Country | US
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Telephone | 405-565-4496
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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