Organization
JOSE L. BAUTISTA, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE LUZA BAUTISTA III M.D. (PRESIDENT)
(626) 665-6704
Entity
Organization
Contact information
Practice address
1300 S. SUNSET AVE., WEST COVINA, CA 91790
(626) 960-6999
(626) 337-1231
Mailing address
2716 S. ERIN CT., WALNUT, CA 91789-4638
(626) 665-6704
(909) 444-7622
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A35250
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A352500
—
CA
Enumeration date
10/03/2006
Last updated
08/22/2020
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