Healthcare Provider Details

I. General information

NPI: 1457297863
Provider Name (Legal Business Name): JAVIER O BAUTISTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 W 5TH ST
OXNARD CA
93030-7105
US

IV. Provider business mailing address

141 W 5TH ST
OXNARD CA
93030-7105
US

V. Phone/Fax

Practice location:
  • Phone: 805-240-2538
  • Fax:
Mailing address:
  • Phone: 805-240-2538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-Z2UUGR
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: