Healthcare Provider Details

I. General information

NPI: 1285563262
Provider Name (Legal Business Name): CHRISTIAN R BAUTISTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 W ANN RD STE 110
NORTH LAS VEGAS NV
89031-4412
US

IV. Provider business mailing address

12372 VALLEY CHASE AVE
LAS VEGAS NV
89138-4615
US

V. Phone/Fax

Practice location:
  • Phone: 702-396-7100
  • Fax:
Mailing address:
  • Phone: 702-580-6308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: