Provider Demographics
NPI:1053501213
Name:ARWINNAH BAUTISTA MD, PC
Entity Type:Organization
Organization Name:ARWINNAH BAUTISTA MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:ARWINNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-434-2813
Mailing Address - Street 1:1430 E PLAZA BLVD STE E18&E19A
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3665
Mailing Address - Country:US
Mailing Address - Phone:619-434-2813
Mailing Address - Fax:855-631-3720
Practice Address - Street 1:1430 E PLAZA BLVD STE E18&E19A
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3665
Practice Address - Country:US
Practice Address - Phone:619-434-2813
Practice Address - Fax:855-631-3720
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-25
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00C512210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05473ZMedicare PIN