Daisy I .Bautista, MD, a Medical Corporation

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A36896 Issued in CA

Legal business name

DAISY I .BAUTISTA, MD, A MEDICAL CORPORATION

Doing business as

Holy Mary Medical Clinic

Practice address

1930 Wilshire Blvd
Ste. 803
Los Angeles, CA 90057-3605

Phone

(213) 483-3968

Fax

(213) 483-3495

NPI assigned

Jul 16, 2006

Last updated

Jun 12, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Daisy Ibanez Bautista, M.D.NPI 1306856992

Title

President Owner

Phone

(213) 483-3968

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Holy Mary Medical Clinic Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daisy Ibanez Bautista, MD

  • Family Medicine Physician
  • Los Angeles, CA
  • NPI 1306856992

  Pediatrics

  NPD (past) Authorized official

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402531200000",
    "number": "1689691537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 WILSHIRE BLVD",
            "address_2": "STE. 803",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900573605",
            "telephone_number": "213-483-3968",
            "fax_number": "213-483-3495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 WILSHIRE BLVD",
            "address_2": "STE. 803",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900573605",
            "telephone_number": "213-483-3968",
            "fax_number": "213-483-3495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAISY I .BAUTISTA, MD, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2014-06-12",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "DAISY",
        "authorized_official_middle_name": "IBANEZ",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "213-483-3968",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A36896",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A36896",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "F84330",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Holy Mary Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Junisa Dailey
• Lucas Dailey
• Angelina Dailo
• Raina Lynn Daily
• Daisy Home Health
• La Shelle Elaina Daisy
• Rachel Dajani, MD
• Earl T Dakan, CRNA
• Gilad Dakik, MSW
• Matteo Dal Monte, MSW

• Pediatrics Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; 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.