Marivic A Bautista, MD
Family Medicine, Adult Medicine in Los Angeles, CA. Individual provider (NPI-1).
NPI number1760680243
StatusActive
Last updated in NPPESApr 4, 2024
Details
- NPI
- 1760680243
- Entity type
- Individual (NPI-1)
- Name
- Marivic A Bautista
- Credential
- MD
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jul 6, 2007
- Certification date
- Apr 4, 2024
- Last updated
- Apr 4, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207QA0505X | Family Medicine, Adult Medicine | A100478 | CA | Yes |
Practice location
5427 Whittier BlvdLos Angeles, CA 90022-4101
Phone 888-499-9303
Mailing address
5427 Whittier BlvdLos Angeles, CA 90022-4101
Phone 888-499-9303
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