| Bautista Medical Group Southern California, Inc. | |
|
427 Central Ave Fillmore CA 93015 | |
| (805) 524-0777 | |
| (805) 524-0111 |
| Full Name | Bautista Medical Group Southern California, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 427 Central Ave, Fillmore, California |
| Authorized Official Name and Position | Jose Luis Bautista (INTERNIST) |
| Authorized Official Contact | 8055242559 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bautista Medical Group Southern California, Inc. 427 Central Ave Fillmore CA 93015-1329 Ph: (805) 524-2559 | Bautista Medical Group Southern California, Inc. 427 Central Ave Fillmore CA 93015 Ph: (805) 524-0777 |
| NPI Number | 1629101340 |
|---|---|
| Provider Enumeration Date | 03/13/2007 |
| Last Update Date | 01/31/2023 |
| Medicare PECOS PAC ID | 6406801604 |
|---|---|
| Medicare Enrollment ID | O20050321000980 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629101340 | NPI | - | NPPES |
| GR0063042 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A43293 (California) | Primary |
| 207Q00000X | Family Medicine | PA15385 (California) | Secondary |
| 207Q00000X | Family Medicine | A97270 (California) | Secondary |
| Provider Name | Luis Bautista |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295712206 PECOS PAC ID: 2668505785 Enrollment ID: I20100727000116 |
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