Provider Demographics
NPI:1831517358
Name:BAUTISTA, JHOANNE (MD PHD)
Entity type:Individual
Prefix:
First Name:JHOANNE
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:KAISER PERMANENTE SAN LEANDRO
Mailing Address - Street 2:2500 MERCED STREET
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577
Mailing Address - Country:US
Mailing Address - Phone:510-298-2146
Mailing Address - Fax:
Practice Address - Street 1:KAISER PERMANENTE SAN LEANDRO
Practice Address - Street 2:2500 MERCED STREET
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577
Practice Address - Country:US
Practice Address - Phone:510-298-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA138904208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery