Provider Demographics
NPI:1528431970
Name:BAUTISTA, ARLENE (RN, BSN)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2557 E GOSHEN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0503
Mailing Address - Country:US
Mailing Address - Phone:559-704-6796
Mailing Address - Fax:800-496-0381
Practice Address - Street 1:2557 E GOSHEN AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0503
Practice Address - Country:US
Practice Address - Phone:559-704-6796
Practice Address - Fax:800-496-0381
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABL10120567253Z00000X
310400000X, 315P00000X
CA637370163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities