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Organization
RAYMUNDO S BAUTISTA, MD, PROF CORP
Active
Organization
RAYMUNDO S BAUTISTA, MD, PROF CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMUNDO SEVILLA BAUTISTA M.D. (PRESIDENT)
(626) 914-3871
Entity
Organization
Contact information
Practice address
118 W FOOTHILL BLVD, GLENDORA, CA 91741-3364
(626) 914-3871
(626) 963-2816
Mailing address
118 W FOOTHILL BLVD, GLENDORA, CA 91741-3364
(626) 914-3871
(626) 963-2816
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A52874
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A528740
—
CA
01
—
A52874
PRES. MEDICAL STATE LIC#
CA
Enumeration date
02/23/2007
Last updated
08/31/2012
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