Micah S Bautista, RDN | |
600 Coffee Rd, Modesto, CA 95355-4201 | |
(209) 550-4747 | |
Not Available |
Full Name | Micah S Bautista |
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Gender | Female |
Speciality | Dietitian, Registered |
Location | 600 Coffee Rd, Modesto, California |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1164175063 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | 86289720 (California) | Primary |
Provider Name | Sutter Valley Medical Foundation |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1669846986 PECOS PAC ID: 9830094515 Enrollment ID: O20090311000335 |
Mailing Address | Practice Location Address |
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Micah S Bautista, RDN 4601 Dale Rd, Modesto, CA 95356-9718 Ph: (209) 735-5000 | Micah S Bautista, RDN 600 Coffee Rd, Modesto, CA 95355-4201 Ph: (209) 550-4747 |
Be Food Wise Dietitian Medicare: Not Enrolled in Medicare Practice Location: 931 10th St Ste 771, Modesto, CA 95354 Phone: 209-771-4717 | |
Beth Goodridge, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 931 10th St Ste 771, Modesto, CA 95354 Phone: 209-771-4717 | |
Mireille Salib, Dietitian Medicare: Not Enrolled in Medicare Practice Location: 4601 Dale Rd, Modesto, CA 95356 Phone: 209-735-5000 | |
Lauren Renee Pavlov, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1441 Florida Ave, Modesto, CA 95350 Phone: 209-578-1211 | |
Amanda Johnson, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 4601 Dale Rd, Modesto, CA 95356 Phone: 209-735-5086 | |
Megan Mirza, RD Dietitian Medicare: Medicare Enrolled Practice Location: 600 Coffee Rd, Modesto, CA 95355 Phone: 209-550-4747 |