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NPI Code Detail

MEDICARE: MARIA C BAUTISTA MD INC

MEDICARE: MARIA C BAUTISTA MD INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianA41768CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215036462
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARIA C BAUTISTA MD INC
Provider Business Mailing Address
First Line : PO BOX 1770
Second Line :
City : LA MESA
State : CA
Zip : 91944-1770
Country : US
Telephone Number : 858-722-4779
Fax Number :
Provider Business Practice Location Address
First Line : 11878 AVENUE OF INDUSTRY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92128-3423
Country : US
Telephone Number : 858-722-4779
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. MARIA CORAZON BAUTISTA
Credential : M.D.
Telephone Number : 858-722-4779
Provider Enumeration Date : 09/22/2006
Last Update Date : 02/24/2020

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Directions to “MARIA C BAUTISTA MD INC ” Practice Location

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