NPIMap

Individual provider Active NPI

Daisy Ibanez Bautista, MD

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1306856992
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A36896 Issued in CA
Practice address
1930 Wilshire Blvd
#803
Los Angeles, CA 90057-3605
Phone
(213) 483-3968
Fax
(213) 483-3495
NPI assigned
Aug 8, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A368969 CA
General Practice Physician 208D00000X A368969 CA
Family Medicine Physician 207Q00000X A36896 CA Primary

Addresses

Primary practice location

1930 Wilshire Blvd
#803
Los Angeles, CA 90057-3605

Mailing address

465 Salem St Apt 104
Glendale, CA 91203-2976
Phone (213) 399-4451

Other identifiers 1

IdentifierTypeStateIssuer
F84330MedicaidCA

Other names 1

  • Maria Bautista Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050517000823 CA Practitioner - Family PracticePractitioner - General Practice 7416998711 Reassigns benefits to 4 organizations
Practice locations: Los Angeles, CA

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: General Practice
Education
Other, 1969
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mobile Medical Group Inc.Group PAC ID 8224397963, 12 clinicians

Practice addresses (Care Compare)

130 N Brand Blvd
Suite 208
Glendale, CA 91203-2627
Phone (818) 945-6003

Hospital & facility affiliations

  • Desante Home Health, Inc. Home health agency, Van Nuys, CA, CCN 757226
  • Universal Preventive Home Health Care, Inc. Home health agency, Simi Valley, CA, CCN 059522
  • Belani Home Health Care, Inc Home health agency, Burbank, CA, CCN 559125
  • Ultimate Care Health Care Home health agency, Los Angeles, CA, CCN 757621
  • Heroic Home Health Care Home health agency, Van Nuys, CA, CCN 757561
  • Exceptional Hospice Care Hospice, Upland, CA, CCN B51745
  • Your Choice Palliative Care, Inc Hospice, Burbank, CA, CCN B21726
  • Embrace Healthcare Hospice, N Hollywood, CA, CCN 751620
  • Eden Hospice, Inc Hospice, Cathedral City, CA, CCN B41572
  • Pure Soul Hospice, Inc Hospice, North Hollywood, CA, CCN A11655

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A36896CAMDFamily Medicine Physician
A368969CAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mobile Medical Group Inc Family Medicine CurrentSince Sep 3, 2019 Accepting new patients
California Mobile Medical Group Inc Family Medicine CurrentSince Dec 6, 2023 Accepting new patients
Daisy I .Bautista, MD, a Medical Corporation Pediatrics Past Accepting new patients
Family Home Health Care Inc PastSince Nov 1, 2018 Accepting new patients
Blikian Chiropractic and Acupuncture Inc PastSince Sep 21, 2020 Accepting new patients
Hagop Blikian Chiropractic Inc Past Accepting new patients

Locations

655 N Central Ave
Ste 1734
Glendale, CA 91203
Phone (818) 945-6003

130 N Brand Blvd
Ste 208
Glendale, CA 91203
Phone (818) 945-6003

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Exceptional Hospice CareUpland, CA, CCN B51745 Hospice Contracted Managing Employee Feb 15, 2026

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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 10

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": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1306856992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "465 SALEM ST APT 104",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912032976",
            "telephone_number": "213-399-4451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 WILSHIRE BLVD",
            "address_2": "#803",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900573605",
            "telephone_number": "213-483-3968",
            "fax_number": "213-483-3495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "DAISY",
        "middle_name": "IBANEZ",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-08",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A368969",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A368969",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A36896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "F84330",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "BAUTISTA",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.