Provider Demographics
NPI:1275321952
Name:OSSA BAUTISTA, DAVID
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:OSSA BAUTISTA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 BISCAYNE BLVD APT 1201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3280
Mailing Address - Country:US
Mailing Address - Phone:786-795-5173
Mailing Address - Fax:
Practice Address - Street 1:4250 BISCAYNE BLVD APT 1201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3280
Practice Address - Country:US
Practice Address - Phone:786-795-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH27681101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health