| Maria C Bautista Md Inc | |
|
11878 Avenue Of Industry San Diego CA 92128-3423 | |
| (858) 722-4779 | |
| Not Available |
| Full Name | Maria C Bautista Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 11878 Avenue Of Industry, San Diego, California |
| Authorized Official Name and Position | Maria Corazon Bautista (PRESIDENT) |
| Authorized Official Contact | 8587224779 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maria C Bautista Md Inc Po Box 1770 La Mesa CA 91944-1770 Ph: (858) 722-4779 | Maria C Bautista Md Inc 11878 Avenue Of Industry San Diego CA 92128-3423 Ph: (858) 722-4779 |
| NPI Number | 1215036462 |
|---|---|
| Provider Enumeration Date | 09/22/2006 |
| Last Update Date | 02/24/2020 |
| Medicare PECOS PAC ID | 5597959486 |
|---|---|
| Medicare Enrollment ID | O20101104000957 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215036462 | NPI | - | NPPES |
| 00A417680 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A41768 (California) | Primary |
| Provider Name | Maria C Bautista |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528167723 PECOS PAC ID: 3577757467 Enrollment ID: I20101104001006 |
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