Most Relevant Information
Provider Data
| NPI Number: | 1003489238 |
| Provider Name: | JORGE BAUTISTA |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/24/2021 |
| Last Updated: | 08/02/2021 |
Provider Practice Location
132 GLYNBROOK ST N
KEIZER
OR
973035796
Practice Location Phone/Fax
| Phone: | 9712279808 |
| Fax: |
Provider Mailing Location
312 MONMOUTH INDEPENDENCE HWY
MONMOUTH
OR
973611730
Provider Mailing Phone/Fax
| Phone: | 9712833664 |
| Fax: |