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General NPI Number Information
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NPI Number | 1518242486
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Entity Type | Individual
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Provider Name | EMY PAULINE TENORIO BAUTISTA D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 11033 ROSECRANS AVE STE D
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City | NORWALK
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State | CA
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Zip | 90650-3663
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Country | US
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Telephone | 562-929-3083
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Fax |
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Provider Business Mailing Address
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Address Line | 12419 CEDARCREEK LN
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City | CERRITOS
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State | CA
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Zip | 90703-2028
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Country | US
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Telephone | 562-644-1309
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 53696
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 53696
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License Number State | CA
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