Healthcare Provider Details

I. General information

NPI: 1700710167
Provider Name (Legal Business Name): ALIKA BAUTISTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24353 SAINT THOMAS AVE
MORENO VALLEY CA
92551-6900
US

IV. Provider business mailing address

24353 SAINT THOMAS AVE
MORENO VALLEY CA
92551-6900
US

V. Phone/Fax

Practice location:
  • Phone: 818-486-3228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: