Individual
DR. DAISY IBANEZ BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1930 WILSHIRE BLVD, #803, LOS ANGELES, CA 90057-3605
(213) 483-3968
(213) 483-3495
Mailing address
465 SALEM ST APT 104, GLENDALE, CA 91203-2976
(213) 399-4451
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A36896
CA
208000000X
Pediatrics Physician
A368969
CA
208D00000X
General Practice Physician
A368969
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
F84330
—
CA
Enumeration date
08/08/2006
Last updated
07/23/2024
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