Provider Demographics
NPI:1376361774
Name:BAUTISTA, IRIS CATALINA (MT)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:CATALINA
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:CATALINA
Other - Last Name:ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:81229 ALBERTA AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-2854
Mailing Address - Country:US
Mailing Address - Phone:442-400-6001
Mailing Address - Fax:
Practice Address - Street 1:73600 ALESSANDRO DR # 122
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3606
Practice Address - Country:US
Practice Address - Phone:442-400-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95932225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist