Basic Information
| Provider Information | |||||||||
| NPI: | 1326573627 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUTISTA | ||||||||
| FirstName: | SARAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 S 700 E STE 2A | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841022855 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019354171 | ||||||||
| FaxNumber: | 8882616694 | ||||||||
| Practice Location | |||||||||
| Address1: | 8350 ARCHIBALD AVE STE 125 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917307701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8019354171 | ||||||||
| FaxNumber: | 8882616694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2017 | ||||||||
| LastUpdateDate: | 04/24/2017 | ||||||||
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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 | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.