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Individual

JEMIANNE BAUTISTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
505 PARNASSUS AVE # M391, SAN FRANCISCO, CA 94143-2204
(415) 476-1537
Mailing address
PO BOX 743749, LOS ANGELES, CA 90074-3749

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
A150437
CA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
A150437
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1801246111
CA
Enumeration date
06/16/2016
Last updated
11/08/2022
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