MEDICARE: MICHAEL 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
1	363LA2100X	Acute Care Nurse Practitioner	95037152	CA

General Provider Information

NPI Number	:	1659210656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BAUTISTA

Provider Business Mailing Address
First Line	:	1054 PARK MEADOWS RD
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1413
Country	:	US
Telephone Number	:	619-988-0357
Fax Number	:

Provider Business Practice Location Address
First Line	:	1054 PARK MEADOWS RD
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1413
Country	:	US
Telephone Number	:	619-988-0357
Fax Number	:

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

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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Directions to “ MICHAEL BAUTISTA ” Practice Location

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