Provider Demographics
NPI:1962515759
Name:BAUTISTA, PAOLA ANDREA (MA, MFT)
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:ANDREA
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7244
Mailing Address - Street 2:MOB # 44
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-7244
Mailing Address - Country:US
Mailing Address - Phone:714-935-8200
Mailing Address - Fax:
Practice Address - Street 1:301 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-935-8200
Practice Address - Fax:714-935-8112
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist