Provider Information for 1033556469
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JACQUELINE BAUTISTA MS
Sex: Female
NPI: 1033556469
Last Updated: 2013-05-24
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1033556469 | ||||||||
| Enumeration Date | 2013-05-24 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1000 SAN LEANDRO BLVD STE 300 SAN LEANDRO, CA 94577-1675 United States Phone: 510-293-7048 | Fax:510-293-7124 | ||||||||
| Primary Practice Address | 1000 SAN LEANDRO BLVD STE 300 SAN LEANDRO, CA 94577-1675 United States Phone: 510-293-7048 | Fax:510-293-7124 | ||||||||
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