| NPI | 1740957455 |
|---|---|
| Former Name | CRYSTAL BAUTISTA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2024-03-15 |