Provider Demographics
NPI:1710115456
Name:RAYMUNDO S. BAUTISTA M.D. APC
Entity Type:Organization
Organization Name:RAYMUNDO S. BAUTISTA M.D. APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMUNDO
Authorized Official - Middle Name:SEVILLA
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-839-9100
Mailing Address - Street 1:1523 E AMAR RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1619
Mailing Address - Country:US
Mailing Address - Phone:626-839-9100
Mailing Address - Fax:626-839-9106
Practice Address - Street 1:1523 E AMAR RD
Practice Address - Street 2:SUITE D
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1619
Practice Address - Country:US
Practice Address - Phone:626-839-9100
Practice Address - Fax:626-839-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52874207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty