Individual
DR. NORMAN C. BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1848 N ALVARADO ST, LOS ANGELES, CA 90026-1781
(323) 663-0465
(323) 953-6718
Mailing address
711 W COLLEGE ST, STE 203, LOS ANGELES, CA 90012-3177
(323) 663-0465
(323) 953-6718
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A60200
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A60200
MEDICARE PTAN
CA
Enumeration date
09/14/2006
Last updated
08/15/2017
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