Active NPI
Evangeline Gutierrez Bautista, M.D.
- Family Medicine Physician
- Los Angeles, CA
National Provider Identifier
1912935842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- C50704
- Practice address
- 3631 Crenshaw Blvd
Suite 109
Los Angeles, CA 90016-4869 - Phone
- (323) 734-1414
- NPI assigned
- Jun 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | C50704 | CA | Primary |
Addresses
Primary practice location
3631 Crenshaw Blvd
Suite 109
Los Angeles, CA 90016-4869
Mailing address
201 E Angeleno Ave
Unit 203
Burbank, CA 91502-2947
Phone (818) 846-2116
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50704 | CA | MD | Oral and Maxillofacial Surgery (Dentist) |
| C50704 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kronos Cardia Medical Group, Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
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- Torrance, CA
- NPI 1972541480
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1912935842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 E ANGELENO AVE",
"address_2": "UNIT 203",
"city": "BURBANK",
"state": "CA",
"postal_code": "915022947",
"telephone_number": "818-846-2116"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3631 CRENSHAW BLVD",
"address_2": "SUITE 109",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900164869",
"telephone_number": "323-734-1414"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAUTISTA",
"first_name": "EVANGELINE",
"middle_name": "GUTIERREZ",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "C50704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.