MEDICARE: RAYMUNDO S. BAUTISTA M.D. APC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	A52874	CA

General Provider Information

NPI Number	:	1710115456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAYMUNDO S. BAUTISTA M.D. APC

Provider Business Mailing Address
First Line	:	1523 E AMAR RD
Second Line	:	SUITE D
City	:	WEST COVINA
State	:	CA
Zip	:	91792-1619
Country	:	US
Telephone Number	:	626-839-9100
Fax Number	:	626-839-9106

Provider Business Practice Location Address
First Line	:	1523 E AMAR RD
Second Line	:	SUITE D
City	:	WEST COVINA
State	:	CA
Zip	:	91792-1619
Country	:	US
Telephone Number	:	626-839-9100
Fax Number	:	626-839-9106

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. RAYMUNDO SEVILLA BAUTISTA
Credential	:	M.D.
Telephone Number	:	626-839-9100

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	07/01/2009

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