Provider Demographics
NPI:1306398987
Name:BAUTISTA, JANELLA RAE PALAO
Entity Type:Individual
Prefix:
First Name:JANELLA RAE
Middle Name:PALAO
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SIERRA SCHOOL AT LIVERMORE
Mailing Address - Street 2:2451 PORTOLA AVE
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551
Mailing Address - Country:US
Mailing Address - Phone:925-775-5785
Mailing Address - Fax:
Practice Address - Street 1:SIERRA SCHOOL AT LIVERMORE (LAWERENCE ELEMENTARY)
Practice Address - Street 2:2451 PORTOLA AVE
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551
Practice Address - Country:US
Practice Address - Phone:925-775-5785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator