Individual provider Active NPI

Marie Angela M Bautista, MS, PA-C

  • Physician Assistant
  • San Diego, CA
National Provider Identifier
1225258445
Registry record updated Jul 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA18241 Issued in CA
Practice address
200 W Arbor Dr
MC 8892
San Diego, CA 92103
Phone
(619) 543-7777
Fax
(619) 543-2652
NPI assigned
Apr 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA18241 CA Primary

Addresses

Primary practice location

200 W Arbor Dr
MC 8892
San Diego, CA 92103

Mailing address

File 57326
Los Angeles, CA 90074-7326
Phone (800) 926-8273

Other practice location 1

9300 Campus Point Dr
LA Jolla, CA 92037-1300
Phone (800) 926-8273

Other practice location 2

9434 Medical Center Dr
LA Jolla, CA 92037-1337
Phone (800) 926-8273

Other names 1

  • Angela Bautista Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090224000141 CA Practitioner - Physician Assistant 6406911502 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the University of CaliforniaGroup PAC ID 3577476761, shared by 18 NPIs, 2,047 clinicians

Practice addresses (Care Compare)

200 W Arbor Dr
San Diego, CA 92103-9000

9300 Campus Point Dr
La Jolla, CA 92037-1300

9350 Campus Point Dr
La Jolla, CA 92037-1300
Phone (800) 926-8273

9434 Medical Ctr Dr
La Jolla, CA 92037-1337
Phone (800) 926-8273

Hospital & facility affiliations

  • UC San Diego Health Hillcrest - Hillcrest Med Ctr Hospital, San Diego, CA, CCN 050025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA18241CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Nov 1, 2008 Accepting new patients
Regents of the University of California CurrentSince Nov 1, 2008 Accepting new patients
Regents of the University of California Current Accepting new patients
Regents of the University of California CurrentSince Jun 20, 2018 Accepting new patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients

Locations

9300 Campus Point Dr
La Jolla, CA 92037
Phone (619) 957-7000

File 57326
Los Angeles, CA 90074

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

200 W Arbor Dr
#8892
San Diego, CA 92103
Phone (619) 543-7478

Organizations & group practices 6

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783641600000",
    "number": "1225258445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE 57326",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900747326",
            "telephone_number": "800-926-8273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "address_2": "MC 8892",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92103",
            "telephone_number": "619-543-7777",
            "fax_number": "619-543-2652"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9300 Campus Point Dr",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920371300",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9434 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920371337",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "MARIE ANGELA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "MS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-27",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA18241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "BAUTISTA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.