# HOME CARE MD MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Home Care MD Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023644556
- **Authorized official:** SHYLEE BAUTISTA TIAMSON FNP (NURSE PRACTITIONER)
- **Authorized official phone:** (310) 292-0117

## Contact information

- **Practice address:** 100 N BARRANCA ST \# 900-J, WEST COVINA, CA 91791-1637
- **Practice address phone:** (626) 377-7608
- **Practice address fax:** (626) 206-0553
- **Mailing address:** 100 N BARRANCA ST \# 900-J, WEST COVINA, CA 91791-1637
- **Mailing address phone:** (626) 377-7608
- **Mailing address fax:** (626) 206-0553

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 2083X0100X | Occupational Medicine Physician | — | NULL | — |
| 2083X0100X | Occupational Medicine Physician | — | — | — |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/16/2020
- **Last updated:** 06/14/2021