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General NPI Number Information
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NPI Number | 1306856992
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Entity Type | Individual
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Provider Name | DAISY IBANEZ BAUTISTA MD
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 1930 WILSHIRE BLVD #803
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City | LOS ANGELES
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State | CA
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Zip | 90057-3605
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Country | US
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Telephone | 213-483-3968
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Fax | 213-483-3495
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Provider Business Mailing Address
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Address Line | 465 SALEM ST APT 104
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City | GLENDALE
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State | CA
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Zip | 91203-2976
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Country | US
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Telephone | 213-399-4451
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A368969
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A368969
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A36896
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License Number State | CA
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