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General NPI Number Information
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NPI Number | 1376361774
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Entity Type | Individual
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Provider Name | IRIS CATALINA BAUTISTA MT
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Gender | Female
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 73600 ALESSANDRO DR # 122
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City | PALM DESERT
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State | CA
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Zip | 92260-3606
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Country | US
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Telephone | 442-400-6001
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Fax |
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Provider Business Mailing Address
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Address Line | 81229 ALBERTA AVE
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City | INDIO
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State | CA
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Zip | 92201-2854
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Country | US
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Telephone | 442-400-6001
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 95932
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License Number State | CA
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