| Doctor Name: | AMBER BAUTISTA |
| NPI Number: | 1295076081 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1870 S Boulder Ave Tulsa, OK - 741195234 |
| Business Phone Number: | 9185851213 |
| Business Fax Number: | 9187438845 |
| Mailing Address: | 3732 S Indianapolis Ave, 203 TULSA |
| State: | OK |
| Postal Code: | 741352285 |
| Phone Number: | 4055654496 |
| Fax Number: | |
| NPI Enumeration Date: | 03/05/2013 |
| NPI Last Update Date: | 03/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |