Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 56217 | CA |
Y | 213EG0000X | General Practice | 56217 | CA |
NPI | 1003083965 |
---|---|
Provider Name | Dr. Reymond Carbonell Bautista |
First Address | Davis, CA 95616-1271 |
Second Address | Davis, CA 95616-1271 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2008 |
Last Update Date | 09/05/2008 |