Libia Elena Bautista

Primary specialty

Dental AssistantTaxonomy code 126800000X

License

RDA91293 Issued in CA

Practice address

2604 S Vermont Ave Ste F
Los Angeles, CA 90007-2298

Phone

(323) 731-3333

NPI assigned

Feb 5, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Cohen Sedgh, Manavi & Pakravan Dental Corporation

  • Dentist
  • Los Angeles, CA
  • NPI 1164767489
  NPD (past)
• Farid Pakravan, D.D.S., Inc.

  • General Practice Dentistry
  • Los Angeles, CA
  • NPI 1346464898
  NPD (past)

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

{
    "created_epoch": "1580860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580860800000",
    "number": "1407488646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3857 DURFEE AVE",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917322505",
            "telephone_number": "626-766-9705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 S VERMONT AVE STE F",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900072298",
            "telephone_number": "323-731-3333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "LIBIA",
        "middle_name": "ELENA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-05",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "CA",
            "license": "RDA91293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Bautista
• Jasmine Bautista
• Jeffri Bautista
• Jelio Bautista
• Katelyn Jailene Bautista
• Luis Danny Bautista Jr.
• Maria Bautista
• Maricela Bautista, RN
• Marivic A Bautista, MD
• Norman C. Bautista, M.D.

• Dental Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Dental Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.