| Doctor Name: | CARLOS M BASTIDAS |
| NPI Number: | 1043616972 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN-BSN |
| License Number: | 561861 |
| Business Practice Address: | 6360 98th St Apartment B-17 Rego Park, NY - 113742238 |
| Business Phone Number: | 9177059578 |
| Business Fax Number: | |
| Mailing Address: | 6360 98th St, Apartment B-17 REGO PARK |
| State: | NY |
| Postal Code: | 113742238 |
| Phone Number: | 9177059578 |
| Fax Number: | |
| NPI Enumeration Date: | 11/04/2014 |
| NPI Last Update Date: | 11/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WE0003X |
| License Number: | 561861 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Emergency |
| Taxonomy Definition: | |