ELAINE REYES BAUTISTA, PA - NPI NUMBER 1790953222

Summary

Provider Name: ELAINE REYES BAUTISTA, PA

NPI Number: 1790953222

Clasification: Physician Assistant (363A00000X)

Address:
39000 BOB HOPE DR
HAL B WALLIS BLDG
RANCHO MIRAGE, CA
ZIP 92270

Phone Number: (760) 346-0642



Detailed Information

Elaine Reyes Bautista, PA is a physician assistant in Rancho Mirage, 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. The assigned NPI number for this provider is 1790953222 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

39000 BOB HOPE DR
HAL B WALLIS BLDG
RANCHO MIRAGE, CA
ZIP 92270-221
Phone: (760) 346-0642
Fax: (760) 404-1376

The enumeration date for this NPI number is 2/19/2008 and was last updated on 2/19/2008.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 363A00000X Physician Assistant PA19574 CA Yes

NPI Record

No. Field Name Field Value
1 NPI 1790953222
2 Entity Type Code 1
3 Provider Last Name Legal Name BAUTISTA
4 Provider First Name ELAINE
5 Provider Middle Name REYES
6 Provider Credential Text PA
7 Provider First Line Business Practice Location Address 39000 BOB HOPE DR
8 Provider Second Line Business Practice Location Address HAL B WALLIS BLDG
9 Provider Business Practice Location Address City Name RANCHO MIRAGE
10 Provider Business Practice Location Address State Name CA
11 Provider Business Practice Location Address Postal Code 922703221
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 7603460642
14 Provider Business Practice Location Address Fax Number 7604041376
15 Provider Enumeration Date 2/19/2008
16 Last Update Date 2/19/2008
17 Provider Gender Code F
18 Healthcare Provider Taxonomy Code 1 363A00000X
19 Provider License Number 1 PA19574
20 Provider License Number State Code 1 CA
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Sole Proprietor N

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.