Provider Demographics
NPI:1225704570
Name:BAUTISTA, LOURDES S (RN BSN)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:S
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16461 SHERMAN WAY STE 160
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3810
Mailing Address - Country:US
Mailing Address - Phone:818-208-9388
Mailing Address - Fax:818-208-9083
Practice Address - Street 1:16461 SHERMAN WAY STE 160
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3810
Practice Address - Country:US
Practice Address - Phone:818-208-9388
Practice Address - Fax:818-208-9083
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA635480163W00000X, 163WI0500X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health