Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 33130 | CA |
N | 111NP0017X | Pediatric Chiropractor | 33130 | CA |
NPI | 1932507738 |
---|---|
Provider Name | Aimee Bautista |
First Address | Huntington Beach, CA 92648-1708 |
Second Address | Huntington Beach, CA 92648-1708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2014 |
Last Update Date | 18/05/2016 |