| Daisy I .bautista, Md, A Medical Corporation | |
|
1930 Wilshire Blvd Ste. 803 Los Angeles CA 90057-3605 | |
| (213) 483-3968 | |
| (213) 483-3495 |
| Full Name | Daisy I .bautista, Md, A Medical Corporation |
|---|---|
| Speciality | Pediatrics |
| Location | 1930 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Daisy Ibanez Bautista (PRESIDENT OWNER) |
| Authorized Official Contact | 2134833968 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Daisy I .bautista, Md, A Medical Corporation 1930 Wilshire Blvd Ste. 803 Los Angeles CA 90057-3605 Ph: (213) 483-3968 | Daisy I .bautista, Md, A Medical Corporation 1930 Wilshire Blvd Ste. 803 Los Angeles CA 90057-3605 Ph: (213) 483-3968 |
| NPI Number | 1689691537 |
|---|---|
| Provider Enumeration Date | 07/16/2006 |
| Last Update Date | 06/12/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689691537 | NPI | - | NPPES |
| F84330 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | A36896 (California) | Secondary |
| 208000000X | Pediatrics | A36896 (California) | Primary |
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