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General NPI Number Information
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NPI Number | 1285219634
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Entity Type | Organization
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Legal Business Name | RAYMOND BAUTISTA DPM, INC
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Dates
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Enumeration Date | 03/16/2021
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 701 E 28TH ST STE 111
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City | LONG BEACH
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State | CA
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Zip | 90806-2715
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Country | US
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Telephone | 562-426-2551
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 VALLEY VIEW RD APT 1
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City | GLENDALE
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State | CA
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Zip | 91202-1721
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RAYMOND BAUTISTA
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Credential | DPM
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Telephone | 818-430-6312
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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