Healthcare Provider Details

I. General information

NPI: 1336385244
Provider Name (Legal Business Name): SESPE MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 SESPE AVE
FILLMORE CA
93015
US

IV. Provider business mailing address

552 SESPE AVE
FILLMORE CA
93015
US

V. Phone/Fax

Practice location:
  • Phone: 805-524-2559
  • Fax: 805-524-2596
Mailing address:
  • Phone: 805-524-2559
  • Fax: 805-524-2596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE LUIS BAUTISTA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 559-271-7292