Provider Demographics
NPI:1063278943
Name:WESTCOAST TRAUMA AND TESTING SPECIALISTS, INC.
Entity type:Organization
Organization Name:WESTCOAST TRAUMA AND TESTING SPECIALISTS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED CLINICAL PS
Authorized Official - Phone:916-234-6585
Mailing Address - Street 1:110 BLUE RAVINE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4712
Mailing Address - Country:US
Mailing Address - Phone:916-505-4419
Mailing Address - Fax:916-805-5145
Practice Address - Street 1:110 BLUE RAVINE RD STE 104
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4712
Practice Address - Country:US
Practice Address - Phone:916-234-6585
Practice Address - Fax:916-805-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty