Gloria Bautista
Individual provider Active NPI Clinical Social Worker · Banning, CA
NPI 1124860432 · NPPES record last updated Jun 7, 2024
Key facts
- NPI
- 1124860432
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 122706 (CA)
- Practice address
- 940 E Williams St Ste 102
Banning, CA 92220-5848 - Phone
- (951) 588-2553
- Fax
- (951) 755-8992
- NPI assigned
- Jun 7, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 122706 | CA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 122706 | CA | Yes |
Addresses
Primary practice location
940 E Williams St Ste 102
Banning, CA 92220-5848
Mailing address
940 E Williams St Ste 102
Banning, CA 92220-5848
Phone (951) 588-2553
Other providers in Banning, CA
- Banning Unified School District
- Amy Barber
- Christopher L Barbian
- Jeanell Barker
- Angelena Nellie Barragun
- Beaver Medical Group LP
- Beaver Medical Group P C
- Beaver Medical Group Ramsey Primary
- Beaver Medical Group, LP
- Christopher Ray Becerra
All providers in Banning, CA · Clinical Social Worker in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.