Provider Demographics
NPI:1881380749
Name:BAUTISTA, STEVIE MAE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STEVIE
Middle Name:MAE
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 TORREY PINE DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8917
Mailing Address - Country:US
Mailing Address - Phone:310-938-2651
Mailing Address - Fax:
Practice Address - Street 1:780 SIMMS ST STE 200
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-4725
Practice Address - Country:US
Practice Address - Phone:303-595-2727
Practice Address - Fax:303-595-2626
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007842363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty