NPIMap

Organization Active NPI

Cedric M. Bautista M.D., a Medical Corporation

  • Surgery Physician
  • El Centro, CA
National Provider Identifier
1124392725
Registry record updated Feb 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A37997 Issued in CA
Legal business name
CEDRIC M. BAUTISTA M.D., A MEDICAL CORPORATION
Practice address
1500 S Imperial Ave
El Centro, CA 92243-4241
Phone
(760) 353-6200
Fax
(760) 353-9817
NPI assigned
Feb 28, 2012
Last updated
Feb 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2012

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

Authorized official

Name
Cedric M Bautista, M.D.
Title
Owner
Phone
(760) 353-6200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X A37997 CA Primary

Addresses

Primary practice location

1500 S Imperial Ave
El Centro, CA 92243-4241

Mailing address

PO Box 2010
El Centro, CA 92244-2010
Phone (760) 353-6200

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1330387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330387200000",
    "number": "1124392725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2010",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922442010",
            "telephone_number": "760-353-6200",
            "fax_number": "760-353-9817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S IMPERIAL AVE",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922434241",
            "telephone_number": "760-353-6200",
            "fax_number": "760-353-9817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDRIC M. BAUTISTA M.D., A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-28",
        "last_updated": "2012-02-28",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "CEDRIC",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-353-6200",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A37997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Centro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2012; 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.