Provider Demographics
NPI:1902062748
Name:BAUTISTA, JOSEFINA ODULIO (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:JOSEFINA
Middle Name:ODULIO
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4172 GAMMA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92113-4116
Mailing Address - Country:US
Mailing Address - Phone:619-262-4506
Mailing Address - Fax:
Practice Address - Street 1:4172 GAMMA ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-4116
Practice Address - Country:US
Practice Address - Phone:619-262-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor