Organization
DAISY I .BAUTISTA, MD, A MEDICAL CORPORATION
Active
Other names
Holy Mary Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAISY IBANEZ BAUTISTA M.D. (PRESIDENT OWNER)
(213) 483-3968
Entity
Organization
Contact information
Practice address
1930 WILSHIRE BLVD, STE. 803, LOS ANGELES, CA 90057-3605
(213) 483-3968
(213) 483-3495
Mailing address
1930 WILSHIRE BLVD, STE. 803, LOS ANGELES, CA 90057-3605
(213) 483-3968
(213) 483-3495
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A36896
CA
208D00000X
General Practice Physician
A36896
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
F84330
—
CA
Enumeration date
07/16/2006
Last updated
06/12/2014
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