Individual
LAYLA REGINA BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
(831) 454-4663
Mailing address
1400 EMELINE AVE, SANTA CRUZ, CA 95060-1976
(831) 454-4170
(831) 454-4663
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
16648-16
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
FHC70042F
—
CA
05
—
FHC70044F
—
CA
01
—
ZZZ92069Z
SANTA CRUZ COUNTY MEDICARE GROUP ID NUMBER
CA
Enumeration date
02/27/2018
Last updated
03/17/2018
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