Organization
BAUTISTA MEDICAL GROUP SOUTHERN CALIFORNIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE LUIS BAUTISTA MD (INTERNIST)
(805) 524-2559
Entity
Organization
Contact information
Practice address
427 CENTRAL AVE, FILLMORE, CA 93015
(805) 524-0777
(805) 524-0111
Mailing address
427 CENTRAL AVE, FILLMORE, CA 93015-1329
(805) 524-2559
(805) 524-2596
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A43293
CA
207Q00000X
Family Medicine Physician
A97270
CA
207Q00000X
Family Medicine Physician
PA15385
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0063042
—
CA
Enumeration date
03/13/2007
Last updated
01/31/2023
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