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General NPI Number Information
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NPI Number | 1639442783
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Entity Type | Individual
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Provider Name | WILFREDO D GARCIA-BAUTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 1405 NW 167TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-5732
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Country | US
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Telephone | 786-248-3588
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Fax | 305-623-7772
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Provider Business Mailing Address
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Address Line | 18081 BISCAYNE BLVD 4N #1103
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City | AVENTURA
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State | FL
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Zip | 33160-2526
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Country | US
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Telephone | 201-708-5375
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Fax | 305-623-7772
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 015455
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License Number State | PR
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