Healthcare Provider Details

I. General information

NPI: 1619943024
Provider Name (Legal Business Name): RICHELLE PILI BAUTISTA-AZORES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N CHINA LAKE BLVD STE 501
RIDGECREST CA
93555
US

IV. Provider business mailing address

1081 N CHINA LAKE BLVD
RIDGECREST CA
93555-3130
US

V. Phone/Fax

Practice location:
  • Phone: 760-499-3846
  • Fax: 760-499-3832
Mailing address:
  • Phone: 760-499-3899
  • Fax: 760-499-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00041126
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPT 12429
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: