Provider Demographics
NPI:1922689173
Name:BAUTISTA, JANET MCCAW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:MCCAW
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S IRENA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3426
Mailing Address - Country:US
Mailing Address - Phone:310-874-1515
Mailing Address - Fax:
Practice Address - Street 1:5035 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5441
Practice Address - Country:US
Practice Address - Phone:310-378-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH58038183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1720003320OtherMEDICARE OSCAR/CERTIFICATION
CA1720003320OtherMEDICARE UPIN
CA1720003320OtherMEDICARE NSC
CA1720003320Medicaid
CA1720003320OtherMEDICARE PIN