Provider Demographics
NPI:1043025448
Name:BAUTISTA, LOURDES (RDN)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WELLS AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3931
Mailing Address - Country:US
Mailing Address - Phone:619-764-3866
Mailing Address - Fax:
Practice Address - Street 1:210 WELLS AVE APT 10
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3931
Practice Address - Country:US
Practice Address - Phone:619-764-3866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered