Provider Demographics
NPI:1992505564
Name:BAUTISTA, ISABELLA ANN
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:ANN
Last Name:BAUTISTA
Suffix:
Gender:
Credentials:
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 112
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-0112
Mailing Address - Country:US
Mailing Address - Phone:424-263-7038
Mailing Address - Fax:
Practice Address - Street 1:1667 262ND ST
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3203
Practice Address - Country:US
Practice Address - Phone:424-263-7038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health