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General NPI Number Information
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NPI Number | 1265640866
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Entity Type | Individual
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Provider Name | CAROLINE A BAUTISTA PHM
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1845 N FAIR OAKS AVE
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City | PASADENA
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State | CA
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Zip | 91103-1620
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Country | US
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Telephone | 626-744-6005
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Fax |
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Provider Business Mailing Address
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Address Line | 2738 HARMONY PL
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City | LA CRESCENTA
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State | CA
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Zip | 91214-2111
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Country | US
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Telephone | 626-744-6011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246QM0900X
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Taxonomy Name | Microbiology Specialist/Technologist
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License Number | PHM35613
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License Number State | CA
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