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BAUTISTA MEDICAL GROUP NPI 1487634317


NPI Information

NPI: 1487634317
Provider Name: BAUTISTA MEDICAL GROUP

Doing Business As: BAUTISTA RESEARCH MEDICAL CLINIC

Classification: Physician Assistant - 363A00000X
Entity Type: Organization

CLIA Number: 05D2133507

Address:
2505 MERCED ST
FRESNO, CA
ZIP 93721
Phone: (559) 445-0391
Get Directions

BAUTISTA MEDICAL GROUP is a physician assistant in Fresno, CA. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. BAUTISTA MEDICAL GROUP NPI is 1487634317. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Bautista Research Medical Clinic.

The provider's business location address is:

2505 MERCED ST
FRESNO, CA
ZIP 93721-811
Phone: (559) 445-0391
Fax: (559) 445-0316

The provider's authorized official is Jose Luis Bautista .
The authorized official title is Medical Director and has the following contact phone number (559) 445-0391.

The CLIA number assigned to this NPI record is 05D2133507 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/18/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1363A00000XPhysician AssistantPA16817CALIFORNIAYes
2208000000XPediatricsA84959CALIFORNIAX
3207R00000XInternal MedicineA43293CALIFORNIAX
4363A00000XPhysician AssistantPA13143CALIFORNIAX
5208D00000XGeneral PracticeA97270CALIFORNIAX
6207Q00000XFamily MedicineX

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GR0063040OTHERCALIFORNIAMEDI-CAL
2ZZZ3862ZOTHERCALIFORNIABLUE SHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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