Provider Demographics
NPI:1164160453
Name:BAUTISTA, BEVERLY LOIDA (RN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:LOIDA
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:BEVERLY
Other - Middle Name:LOIDA
Other - Last Name:DEGRACIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3819 7 TREES BLVD APT 306
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-3369
Mailing Address - Country:US
Mailing Address - Phone:408-963-7594
Mailing Address - Fax:
Practice Address - Street 1:3819 7 TREES BLVD APT 306
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-3369
Practice Address - Country:US
Practice Address - Phone:408-963-7594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA