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General NPI Number Information
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NPI Number | 1326133976
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Entity Type | Individual
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Provider Name | KATHERINE MARJORIE STOUT-BAUTISTA O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 1033 3RD ST
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3107
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Country | US
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Telephone | 415-482-6826
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Fax | 415-482-6726
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Provider Business Mailing Address
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Address Line | 1033 3RD ST
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City | SAN RAFAEL
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State | CA
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Zip | 94901-3107
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Country | US
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Telephone | 415-482-6826
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Fax | 415-482-6726
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT-12944-T
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License Number State | CA
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