Provider Demographics
NPI:1558694646
Name:BAUTISTA ABAYON, NATALIE ANNE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:BAUTISTA ABAYON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:ANNE
Other - Last Name:BAUTISTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IMF
Mailing Address - Street 1:892 27TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1444
Mailing Address - Country:US
Mailing Address - Phone:619-575-4687
Mailing Address - Fax:619-575-1215
Practice Address - Street 1:892 27TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-1444
Practice Address - Country:US
Practice Address - Phone:619-575-4687
Practice Address - Fax:619-575-1215
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
CA65720106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist