Healthcare Provider Details

I. General information

NPI: 1386514123
Provider Name (Legal Business Name): JOSHUA AARON BAUTISTA FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 MACARTHUR BLVD
NEWPORT BEACH CA
92660-2512
US

IV. Provider business mailing address

12141 CENTRALIA ST UNIT 302
LAKEWOOD CA
90715-1566
US

V. Phone/Fax

Practice location:
  • Phone: 949-736-6102
  • Fax: 877-223-5602
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95035952
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: