Individual
DIVINA GRACIA P. BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1239 ADEN ROAD, PASADENA, CA 91125
(626) 395-6393
(626) 585-1522
Mailing address
1239 ARDEN ROAD, PASADENA, CA 91125
(626) 395-6393
(626) 585-1522
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
NP7363
CA
363LP2300X
Primary Care Nurse Practitioner
Primary
NP7363
CA
363LS0200X
School Nurse Practitioner
NP7363
CA
Other
Enumeration date
09/25/2017
Last updated
10/02/2017
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