Healthcare Provider Details

I. General information

NPI: 1689746208
Provider Name (Legal Business Name): BAUTISTA RURAL MEDICAL CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 JENSEN AVE SUITE 106
SANGER CA
93657-2269
US

IV. Provider business mailing address

2570 JENSEN AVE SUITE 106
SANGER CA
93657-2269
US

V. Phone/Fax

Practice location:
  • Phone: 559-875-3428
  • Fax: 559-875-3434
Mailing address:
  • Phone: 559-875-3428
  • Fax: 559-875-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 13143
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21266
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA432930
License Number StateCO

VIII. Authorized Official

Name: MRS. BLANCA E ESCOBAR
Title or Position: BILLING DIRECTOR
Credential:
Phone: 559-875-3428