MEDICARE: IRIS CATALINA BAUTISTA MT

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
1	225700000X	Massage Therapist	95932	CA

General Provider Information

NPI Number	:	1376361774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS CATALINA BAUTISTA MT

Provider Business Mailing Address
First Line	:	81229 ALBERTA AVE
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-2854
Country	:	US
Telephone Number	:	442-400-6001
Fax Number	:

Provider Business Practice Location Address
First Line	:	73600 ALESSANDRO DR # 122
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3606
Country	:	US
Telephone Number	:	442-400-6001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2024
Last Update Date	:	10/03/2024

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Directions to “ IRIS CATALINA BAUTISTA MT” Practice Location

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