Provider Demographics
NPI:1528628450
Name:BAUTISTA, FRANCISCO JAVIER
Entity type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:JAVIER
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 1:15034 FICUS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-7355
Mailing Address - Country:US
Mailing Address - Phone:424-223-7248
Mailing Address - Fax:
Practice Address - Street 1:15034 FICUS ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-7355
Practice Address - Country:US
Practice Address - Phone:424-223-7248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician