Bautista, Mark Gerard D

Bautista, Mark Gerard D is an individual health care provider with primary practice located at 104 W D. L. Ingram Ave. Cannon Afb, Clovis NM 88101. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Bautista, Mark Gerard D can be contacted via phone (575) 904-3831.

Contact Information

Primary practice address
104 W D. L. Ingram Ave. Cannon Afb Clovis NM 88101
Phone: (575) 904-3831
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X

Profile Details

NPI number 1912487455
LBN Legal business name Bautista, Mark Gerard D
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 15th, 2018
Last updated Mar 16th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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