Bautista, Daisy Ibanez
Bautista, Daisy Ibanez is an individual health care provider with primary practice located at 1930 Wilshire Blvd #803, Los Angeles CA 90057-3605. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is her primary health care specialty. Bautista, Daisy Ibanez can be contacted via phone (213) 483-3968.Contact Information
Primary practice address
1930 Wilshire Blvd #803
Los Angeles CA 90057-3605
Phone: (213) 483-3968
Fax: (213) 483-3495
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | A368969 | California |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | A368969 | California |
Profile Details
| NPI number | 1306856992 |
|---|---|
| LBN Legal business name | Bautista, Daisy Ibanez |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 8th, 2006 |
| Last updated | Mar 26th, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306856992 | NPPES |
| California | MEDICAID | F84330 |
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