Healthcare Provider Details

I. General information

NPI: 1033057864
Provider Name (Legal Business Name): MICHELLE BAUTISTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N HANDY ST
ORANGE CA
92867-4434
US

IV. Provider business mailing address

1401 N HANDY ST
ORANGE CA
92867-4434
US

V. Phone/Fax

Practice location:
  • Phone: 714-628-5560
  • Fax: 714-628-4223
Mailing address:
  • Phone: 714-628-5560
  • Fax: 714-628-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number502018
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: