MEDICARE: MRS. ANA MARIA BAUTISTA-GUTIERREZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	15052	OK

General Provider Information

NPI Number	:	1952396947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANA MARIA BAUTISTA-GUTIERREZ MD

Provider Business Mailing Address
First Line	:	7530 NW 25TH ST
Second Line	:	STE B
City	:	BETHANY
State	:	OK
Zip	:	73008-4914
Country	:	US
Telephone Number	:	405-495-6340
Fax Number	:	405-440-9951

Provider Business Practice Location Address
First Line	:	7530 NW 25TH ST
Second Line	:	STE B
City	:	BETHANY
State	:	OK
Zip	:	73008-4914
Country	:	US
Telephone Number	:	405-495-6340
Fax Number	:	405-440-9951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	10/15/2007

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