Healthcare Provider Details

I. General information

NPI: 1568929859
Provider Name (Legal Business Name): KAREN BAUTISTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2019
Last Update Date: 02/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NEVIN AVE
RICHMOND CA
94801-3143
US

IV. Provider business mailing address

2150 JOHN STILL DR
SACRAMENTO CA
95832-1246
US

V. Phone/Fax

Practice location:
  • Phone: 510-307-3057
  • Fax:
Mailing address:
  • Phone: 510-685-7412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number31858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: