Most Relevant Information
Provider Data
| NPI Number: | 1003209685 |
| Provider Name: | SUSIE JULIANA BAUTISTA |
| Entity Type: | Individual |
| Taxonomy Code: | 106H00000X |
| Specialty: | Marriage & Family Therapist |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/06/2015 |
| Last Updated: | 03/06/2015 |
Provider Practice Location
2178 JOHNSON AVE
SAN LUIS OBISPO
CA
934014535
Practice Location Phone/Fax
| Phone: | 8057814960 |
| Fax: |
Provider Mailing Location
2178 JOHNSON AVE
SAN LUIS OBISPO
CA
934014535
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |