Provider Demographics
NPI:1467521864
Name:UY, EDITHA BAUTISTA (MD)
Entity Type:Individual
Prefix:DR
First Name:EDITHA
Middle Name:BAUTISTA
Last Name:UY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 E FRUIT ST STE 111
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701
Mailing Address - Country:US
Mailing Address - Phone:714-543-8269
Mailing Address - Fax:714-543-8260
Practice Address - Street 1:2220 E FRUIT ST STE 111
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:714-543-8269
Practice Address - Fax:714-543-8260
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30550207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A26148Medicare UPIN
A30550Medicare ID - Type Unspecified