Provider Demographics
NPI:1124289079
Name:BAUTISTA OTANEZ, FELIPE SEBASTIAN (MD)
Entity type:Individual
Prefix:
First Name:FELIPE
Middle Name:SEBASTIAN
Last Name:BAUTISTA OTANEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 HAWTHORNE LN STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2467
Practice Address - Country:US
Practice Address - Phone:704-384-1900
Practice Address - Fax:704-384-1919
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2021-008102080P0207X
PAMD4440932080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology