MEDICARE: BAUTISTA RURAL MEDICAL CLINICS, 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
1	363A00000X	Physician Assistant	PA 13143	CA
2	363A00000X	Physician Assistant	PA21266	CA
3	207R00000X	Internal Medicine Physician	A432930	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	BZ069A	OTHER	CA	MEDICARE PTAN / PALMETTO

Other Identifiers

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

General Provider Information

NPI Number	:	1689746208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAUTISTA RURAL MEDICAL CLINICS, INC.

Provider Business Mailing Address
First Line	:	2570 JENSEN AVE
Second Line	:	SUITE 106
City	:	SANGER
State	:	CA
Zip	:	93657-2269
Country	:	US
Telephone Number	:	559-875-3428
Fax Number	:	559-875-3434

Provider Business Practice Location Address
First Line	:	2570 JENSEN AVE
Second Line	:	SUITE 106
City	:	SANGER
State	:	CA
Zip	:	93657-2269
Country	:	US
Telephone Number	:	559-875-3428
Fax Number	:	559-875-3434

Authorized Official
Title or Position	:	BILLING DIRECTOR
Name	:	MRS. BLANCA E ESCOBAR
Credential	:
Telephone Number	:	559-875-3428

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	10/05/2010

Similar Medicare Providers

1134119308 — DR. JOSE LUIS BAUTISTA M.D.
Practice Location Address:

2570 JENSEN AVE STE 106
SANGER, CA
93657-2269

Practice Phone: 559-875-3428
Practice Fax: 559-875-3434

1356322911 — MS. CRISTINA LOPEZ PA
Practice Location Address:

2570 JENSEN AVE , SUITE 102
SANGER, CA
93657-2269

Practice Phone: 559-876-1402
Practice Fax: 559-876-9461

1093820748 — CONRAD THEODORE SEITZ M.D
Practice Location Address:

2570 JENSEN AVE , SUITE 106
SANGER, CA
93657-2269

Practice Phone: 559-875-3428
Practice Fax: 559-875-3434

1386730125 — TEJINDER S SANDHU M.D.
Practice Location Address:

2570 JENSEN AVE STE 103
SANGER, CA
93657-2269

Practice Phone: 559-875-7149
Practice Fax: 559-875-9661

1326134115 — KANWER S DHAMI M.D.
Practice Location Address:

2570 JENSEN AVE STE 103
SANGER, CA
93657-2269

Practice Phone: 559-875-7149
Practice Fax: 559-875-9661

1053484550 — MRS. MARY MOLINA
Practice Location Address:

2570 JENSEN AVE STE 106
SANGER, CA
93657-2269

Practice Phone: 559-875-3428
Practice Fax: 559-875-3434

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