1184969651 NPI number — DANIELLE BAUTISTA A.N.P.

Table of content: DANIELLE BAUTISTA A.N.P. (NPI 1184969651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184969651 NPI number — DANIELLE BAUTISTA A.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUTISTA
Provider First Name:
DANIELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184969651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1848
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVATO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94948-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-495-2225
Provider Business Mailing Address Fax Number:
415-495-2228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
363 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
REDWOOD CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94063-1729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-306-9490
Provider Business Practice Location Address Fax Number:
650-306-0250
Provider Enumeration Date:
12/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  2012013516 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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