Provider Demographics
NPI:1861556391
Name:BAUTISTA, MARGARITA C (PA)
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:C
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SUNVALLEY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5816
Mailing Address - Country:US
Mailing Address - Phone:925-234-4447
Mailing Address - Fax:
Practice Address - Street 1:901 SUNVALLEY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5816
Practice Address - Country:US
Practice Address - Phone:925-234-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-62363A00000X
CAPA 19054363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54656702Medicaid
HI52399Medicare PIN
HIP32509Medicare UPIN