Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | E4157 | CA |
Y | 213ES0000X | Sports Medicine | E4157 | CA |
NPI | 1043265549 |
---|---|
Provider Name | Dr. Raymond M Bautista |
First Address | Long Beach, CA 90806-2759 |
Second Address | Long Beach, CA 90806-2759 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 26/09/2013 |