Provider Demographics
NPI:1720278450
Name:ARWINNAH BAUTISTA M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ARWINNAH BAUTISTA M.D., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARWINNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-985-1845
Mailing Address - Street 1:PO BOX 576825
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6825
Mailing Address - Country:US
Mailing Address - Phone:209-985-1845
Mailing Address - Fax:209-551-8594
Practice Address - Street 1:2612 TEMESCAL DR
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-8698
Practice Address - Country:US
Practice Address - Phone:209-985-1845
Practice Address - Fax:209-551-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty