Organization
BAUTISTA MEDICAL GROUP
Active
Other names
Bautista Research Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE LUIS BAUTISTA MD (MEDICAL DIRECTOR)
(559) 445-0391
Entity
Organization
Contact information
Practice address
2505 MERCED ST, FRESNO, CA 93721-1811
(559) 445-0391
(559) 445-0316
Mailing address
2505 MERCED ST, FRESNO, CA 93721-1811
(559) 445-0391
(559) 445-0316
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
A43293
CA
208000000X
Pediatrics Physician
A84959
CA
208D00000X
General Practice Physician
A97270
CA
363A00000X
Physician Assistant
PA13143
CA
363A00000X
Physician Assistant
PA16817
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0063040
MEDI-CAL
CA
01
—
ZZZ3862Z
BLUE SHIELD
CA
Enumeration date
01/18/2006
Last updated
09/11/2025
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