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General NPI Number Information
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NPI Number | 1689691537
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Entity Type | Organization
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Legal Business Name | DAISY I .BAUTISTA, MD, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 06/12/2014
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Provider Practice Location Address
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Address Line | 1930 WILSHIRE BLVD STE. 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 | 1930 WILSHIRE BLVD STE. 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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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. DAISY IBANEZ BAUTISTA
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Credential | M.D.
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Telephone | 213-483-3968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A36896
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A36896
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License Number State | CA
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