Gabrielle Marie Bautista, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA63361 Issued in CA

Practice address

19231 Soledad Canyon Rd
Canyon Country, CA 91351-3367

Phone

(661) 430-9040

NPI assigned

Sep 21, 2023

Last updated

Feb 20, 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

Locations

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.

• Smartclinic Inc

  • Urgent Care Clinic/Center
  • West Covina, CA
  • NPI 1881828317
  NPD

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

{
    "created_epoch": "1695254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1063291896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 134",
            "city": "CASTAIC",
            "state": "CA",
            "postal_code": "913100134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19231 SOLEDAD CANYON RD",
            "city": "CANYON COUNTRY",
            "state": "CA",
            "postal_code": "913513367",
            "telephone_number": "661-430-9040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "GABRIELLE MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-21",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA63361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Honey Balazadeh, DMD
• Bambi Ballesteros
• Virginia Barnett, LMFT
• Diana Barragan Gomez
• Ophelia G Barte, M.D.
• Linda Bedassian, D.C.
• Marion Behrend, MFT
• Sam Bekhit
• Adriana Mercedes Benamor, LCSW
• Beneda Adhc

• Physician Assistant in Canyon Country, CA
• Providers in Canyon Country, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.