Provider Demographics
NPI:1134224066
Name:BAUTISTA, NORMAN C (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:C
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:711 W COLLEGE ST
Mailing Address - Street 2:STE 203
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3177
Mailing Address - Country:US
Mailing Address - Phone:323-663-0465
Mailing Address - Fax:323-953-6718
Practice Address - Street 1:1848 N ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-1781
Practice Address - Country:US
Practice Address - Phone:323-663-0465
Practice Address - Fax:323-953-6718
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2017-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA60200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA60200OtherMEDICARE PTAN
CAA60200OtherCALIF MEDICAL BOARD
CAH38171Medicare UPIN