Basic Information
| Provider Information | |||||||||
| NPI: | 1164713194 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUTISTA | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | GUERRERO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1805 E FIR AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592989600 | ||||||||
| FaxNumber: | 5592989605 | ||||||||
| Practice Location | |||||||||
| Address1: | 1805 E FIR AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592989600 | ||||||||
| FaxNumber: | 5592989605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2011 | ||||||||
| LastUpdateDate: | 05/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | A122998 | CA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.