Divina Gracia P. Bautista, N.P.

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

NP7363 Issued in CA

Practice address

1239 Aden Road
Pasadena, CA 91125

Phone

(626) 395-6393

Fax

(626) 585-1522

NPI assigned

Sep 25, 2017

Last updated

Oct 2, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Divina Gracia R. Dela Pena Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506902400000",
    "number": "1952810772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1239 ARDEN ROAD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "91125",
            "telephone_number": "626-395-6393",
            "fax_number": "626-585-1522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 ADEN ROAD",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "91125",
            "telephone_number": "626-395-6393",
            "fax_number": "626-585-1522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "DIVINA GRACIA",
        "middle_name": "P.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-25",
        "last_updated": "2017-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP7363",
            "primary": false
        },
        {
            "code": "363LS0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, School",
            "state": "CA",
            "license": "NP7363",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "NP7363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIVINA GRACIA",
            "last_name": "DELA PENA",
            "middle_name": "R.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stephen Baughman, PSYD.
• Ellain Baul-Highfill, PA
• Daniela Baumann
• Anthony Bautista
• Caroline A Bautista, PHM
• Grace Sevilla Bautista, M.D.
• Jessica Maria Bautista
• Jorge L Bautista
• Yadira Bautista
• Yosemite Bautista

• Primary Care Nurse Practitioner in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Primary Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2017; 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.