Liezl Ann Bautista, CPNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95012455 Issued in CA

Practice address

725 Welch Rd
Palo Alto, CA 94304-1601

Phone

(650) 497-8000

NPI assigned

Aug 15, 2019

Reactivated

Sep 12, 2022

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

Credentials

Certified Pediatric Nurse Practitioner

State licenses

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

{
    "created_epoch": "1565827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1083260087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 WELCH RD",
            "city": "PALO ALTO",
            "state": "CA",
            "postal_code": "943041601",
            "telephone_number": "650-497-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4650 W Sunset Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900276062",
            "country_code": "US",
            "telephone_number": "323-600-2450 x19553",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "LIEZL ANN",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-15",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "deactivation_date": "2020-07-15",
        "reactivation_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95012455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Joseph Baum, PA-C
• Allison Kathleen Baumann, LCSW
• Fiona Mitchell Baumer, MD
• Alexandra Baumgarten
• Chanelle Soer Bautista
• Marlon Bautista, RN
• Bay Area House Call Physicians
• Charles Bradley Bay, MD
• Holly-Lyn Paat Bayani
• Leanne Grace Navarro Bayaoa

• Nurse Practitioner in Palo Alto, CA
• Providers in Palo Alto, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2023; 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.