Healthcare Provider Details

I. General information

NPI: 1285549451
Provider Name (Legal Business Name): MISTY ROSE BAUTISTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 N HIGHWAY 59 STE K
MERCED CA
95348-9405
US

IV. Provider business mailing address

3360 N HIGHWAY 59 STE K
MERCED CA
95348-9405
US

V. Phone/Fax

Practice location:
  • Phone: 209-600-1062
  • Fax:
Mailing address:
  • Phone: 209-600-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: