Individual
GREGORY BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6060 N PARAMOUNT BLVD, LONG BEACH, CA 90805-3711
(562) 634-9534
Mailing address
6060 N PARAMOUNT BLVD, LONG BEACH, CA 90805-3711
(562) 634-9534
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95205276
CA
Other
Enumeration date
11/24/2021
Last updated
11/24/2021
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