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General NPI Number Information
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NPI Number | 1952810772
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Entity Type | Individual
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Provider Name | DIVINA GRACIA P. BAUTISTA N.P.
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Gender | Female
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 1239 ADEN ROAD
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City | PASADENA
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State | CA
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Zip | 91125
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Country | US
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Telephone | 626-395-6393
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Fax | 626-585-1522
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Provider Business Mailing Address
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Address Line | 1239 ARDEN ROAD
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City | PASADENA
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State | CA
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Zip | 91125
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Country | US
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Telephone | 626-395-6393
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Fax | 626-585-1522
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP7363
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LS0200X
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Taxonomy Name | School Nurse Practitioner
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License Number | NP7363
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | NP7363
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License Number State | CA
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