Healthcare Provider Details

I. General information

NPI: 1962515759
Provider Name (Legal Business Name): PAOLA ANDREA BAUTISTA M.A., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 THE CITY DR S
ORANGE CA
92868
US

IV. Provider business mailing address

PO BOX 7244 MOB # 44
ORANGE CA
92863-7244
US

V. Phone/Fax

Practice location:
  • Phone: 714-935-8200
  • Fax: 714-935-8112
Mailing address:
  • Phone: 714-935-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: