Provider Demographics
NPI:1699434860
Name:BAUTISTA, RICHARD ADAM (NP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ADAM
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 PLANTATION WAY
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5933
Mailing Address - Country:US
Mailing Address - Phone:707-207-9218
Mailing Address - Fax:
Practice Address - Street 1:213 PLANTATION WAY
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5933
Practice Address - Country:US
Practice Address - Phone:707-207-9218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018526363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner