Provider Demographics
NPI:1154131613
Name:BAUTISTA LARA, DIEGO ARMANDO
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:ARMANDO
Last Name:BAUTISTA LARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3678
Mailing Address - Country:US
Mailing Address - Phone:831-443-0249
Mailing Address - Fax:
Practice Address - Street 1:1121 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3678
Practice Address - Country:US
Practice Address - Phone:831-443-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW124754101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional