Provider Demographics
NPI:1285024083
Name:BAUTISTA, ERICKSON CRUZ (DNP)
Entity Type:Individual
Prefix:DR
First Name:ERICKSON
Middle Name:CRUZ
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18411 CRENSHAW BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5078
Mailing Address - Country:US
Mailing Address - Phone:310-817-5665
Mailing Address - Fax:
Practice Address - Street 1:6926 BROCKTON AVE STE 8
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3804
Practice Address - Country:US
Practice Address - Phone:877-414-7739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-31
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002040363LG0600X, 363L00000X, 363LA2200X
NV822775163WG0600X, 363LA2200X, 363LG0600X
CA715867163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse