Individual
BRIAN GLENN BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9961 SIERRA AVE, FONTANA, CA 92335-6720
(909) 427-3910
Mailing address
1301 CALIFORNIA ST, REDLANDS, CA 92374-2910
(909) 427-3910
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A85008
CA
Other
Enumeration date
01/08/2007
Last updated
11/29/2021
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