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NPI Code Detail

MEDICARE: ANTONNETTE BAUTISTA

MEDICARE: ANTONNETTE BAUTISTA
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
1106S00000XBehavior TechnicianRBT-26-515306NV

General Provider Information

NPI Number : 1578410544
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTONNETTE BAUTISTA
Provider Business Mailing Address
First Line : 3085 E FLAMINGO RD STE A&B
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-4308
Country : US
Telephone Number : 702-605-4437
Fax Number :
Provider Business Practice Location Address
First Line : 9089 S PECOS RD STE 3600
Second Line :
City : HENDERSON
State : NV
Zip : 89074-7186
Country : US
Telephone Number : 702-680-1526
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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Directions to “ ANTONNETTE BAUTISTA ” Practice Location

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