Healthcare Provider Details

I. General information

NPI: 1134047335
Provider Name (Legal Business Name): GAIL BAUTISTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 REDONDO AVE
LONG BEACH CA
90806
US

IV. Provider business mailing address

52 61ST PL
LONG BEACH CA
90803-5669
US

V. Phone/Fax

Practice location:
  • Phone: 844-562-1212
  • Fax:
Mailing address:
  • Phone: 657-248-6383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95371976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: