Provider Demographics
NPI:1326876483
Name:BAUTISTA, KEVINRAY CRUZ
Entity type:Individual
Prefix:MR
First Name:KEVINRAY
Middle Name:CRUZ
Last Name:BAUTISTA
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 1:21221 S WESTERN AVE # 1609
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2970
Mailing Address - Country:US
Mailing Address - Phone:424-206-8161
Mailing Address - Fax:
Practice Address - Street 1:21121 S WESTERN AVENUE
Practice Address - Street 2:1609
Practice Address - City:TORANCE
Practice Address - State:CA
Practice Address - Zip Code:90717
Practice Address - Country:US
Practice Address - Phone:424-206-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)