Provider Demographics
NPI:1740375054
Name:BARUIZ, ALTA GRACE UYTICO (MD)
Entity type:Individual
Prefix:DR
First Name:ALTA GRACE
Middle Name:UYTICO
Last Name:BARUIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALTAGRACIA
Other - Middle Name:UYTICO
Other - Last Name:BARUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10900 TWIN FALLS DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2939
Mailing Address - Country:US
Mailing Address - Phone:661-633-2009
Mailing Address - Fax:661-633-1401
Practice Address - Street 1:2203 19TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3608
Practice Address - Country:US
Practice Address - Phone:661-633-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA062132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG61331Medicare UPIN