Healthcare Provider Details

I. General information

NPI: 1528431970
Provider Name (Legal Business Name): ARLENE BAUTISTA RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2557 E GOSHEN AVE
FRESNO CA
93720-0503
US

IV. Provider business mailing address

2557 E GOSHEN AVE
FRESNO CA
93720-0503
US

V. Phone/Fax

Practice location:
  • Phone: 559-704-6796
  • Fax: 800-496-0381
Mailing address:
  • Phone: 559-704-6796
  • Fax: 800-496-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberBL10120567
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number637370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: