Jessica Bautista de Mora

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

License

T2L7B5K5 Issued in CA

Practice address

1100 N D St
San Bernardino, CA 92410-3524

Phone

(909) 884-0840

NPI assigned

Dec 13, 2022

Last updated

May 17, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• G & C Swan Inc

  dba New Creation Addiction Treatment Center

  • Substance Abuse Rehabilitation Facility
  • Claremont, CA
  • NPI 1740569235
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1670889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1013628700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N D ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924103524",
            "telephone_number": "909-884-0840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N D ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924103524",
            "telephone_number": "909-884-0840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA DE MORA",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-13",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "CA",
            "license": "T2L7B5K5",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leon Bathini Jr., MD
• Whitney R Batson
• Rae Justine Franco Battung
• Gabrielle Annali Bauer
• Wilson Boyd Baugh Jr, D.D.S.
• Karina Bautista-Moreno
• Allison Kathleen Bautista, ASW
• Corbin Baxter, MSW, ASW
• Bayada Home Health Care, Inc.
• Stephanie Bea

• Case Manager/Care Coordinator in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Case Manager/Care Coordinator in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.