Basic Information
| Provider Information | |||||||||
| NPI: | 1184969651 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUTISTA | ||||||||
| FirstName: | DANIELLE | ||||||||
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| Credential: | A.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1848 | ||||||||
| Address2: | |||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949481848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154952225 | ||||||||
| FaxNumber: | 4154952228 | ||||||||
| Practice Location | |||||||||
| Address1: | 363 MAIN ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940631729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503069490 | ||||||||
| FaxNumber: | 6503060250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2012 | ||||||||
| LastUpdateDate: | 04/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 2012013516 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.