Jose L. Bautista, M.D., Inc.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

A35250 Issued in CA

Legal business name

JOSE L. BAUTISTA, M.D., INC.

Practice address

1300 S. Sunset Ave.
West Covina, CA 91790

Phone

(626) 960-6999

Fax

(626) 337-1231

NPI assigned

Oct 3, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jose Luza Bautista III, M.D.NPI 1063514487

Title

President

Phone

(626) 665-6704

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jose Luza Bautista III, M.D.

  • Surgery Physician
  • Walnut, CA
  • NPI 1063514487
  NPD (past) Authorized official

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780778498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2716 S. ERIN CT.",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917894638",
            "telephone_number": "626-665-6704",
            "fax_number": "909-444-7622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 S. SUNSET AVE.",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "91790",
            "telephone_number": "626-960-6999",
            "fax_number": "626-337-1231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSE L. BAUTISTA, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "LUZA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-665-6704",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A35250",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A352500",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jomi Broadmoor Icfddn
• Jonathan J Tye, MD a Professional Corp
• Jeremiah Jones
• Catharine Irene Jordan, REGISTERED NURSE
• Nia M Jordan
• Jojo Jose, RPT
• Joseph a Delgado Licensed Marriage and Family Therapist Prof Corp
• Joseph L Lin MD Inc
• Joshua G Adegbe
• Ali Jouni

• Surgery Physician in West Covina, CA
• Providers in West Covina, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.