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General NPI Number Information
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NPI Number | 1124392725
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Entity Type | Organization
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Legal Business Name | CEDRIC M. BAUTISTA M.D., A MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/28/2012
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 1500 S IMPERIAL AVE
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City | EL CENTRO
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State | CA
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Zip | 92243-4241
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Country | US
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Telephone | 760-353-6200
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Fax | 760-353-9817
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Provider Business Mailing Address
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Address Line | PO BOX 2010
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City | EL CENTRO
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State | CA
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Zip | 92244-2010
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Country | US
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Telephone | 760-353-6200
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Fax | 760-353-9817
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Authorized Official
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Title or Position | OWNER
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Name | CEDRIC M BAUTISTA
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Credential | M.D.
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Telephone | 760-353-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A37997
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License Number State | CA
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