Kenneth Bautista, OTR/L

Primary specialty

Physical Rehabilitation Occupational TherapistTaxonomy code 225XP0019X

License

13617 Issued in CA

Practice address

45 Cleary CT Apt 11
San Francisco, CA 94109-6515

Phone

(415) 572-5922

NPI assigned

Nov 13, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1415836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1245636570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 CLEARY CT APT 11",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941096515",
            "telephone_number": "415-572-5922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 CLEARY CT APT 11",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941096515",
            "telephone_number": "415-572-5922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "KENNETH",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-11-13",
        "last_updated": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "CA",
            "license": "13617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "6600 Bruceville Rd",
            "city": "Sacramento",
            "state": "CA",
            "country_code": "US",
            "postal_code": "95823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Erikson Bautista
• Gregoria Magnaye Bautista, RN
• Jemianne Bautista, M.D.
• Joann D Bautista, RN, PHN, CCM
• John D Bautista, RN
• Laura Renee Bautista, RN
• Lord Mark Bautista
• Marianne Bautista
• Rhea Bautista
• Ronnie Bautista, LCSW

• Physical Rehabilitation Occupational Therapist in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Physical Rehabilitation Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; 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.