Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | A160447 | CA |
NPI | 1326458845 |
---|---|
Provider Name | Judi Anne Bautista Ramiscal |
First Address | Colton, CA 92324-1801 |
Second Address | Colton, CA 92324-1801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2014 |
Last Update Date | 16/09/2021 |