BERTHA ALICIA BAUTISTA LMFT
NPI 1093251001
Marriage & Family Therapist in San Diego, CA

Q: What is Bertha Alicia Bautista's NPI number?

The NPI number for Bertha Alicia Bautista is 1093251001. It was assigned to this individual provider in the NPPES registry on January 13, 2017.

Q: What is Bertha Alicia Bautista's specialty?

The primary specialty registered for this NPI is Marriage & Family Therapist with taxonomy code 106H00000X.

Active since January 13, 2017PECOS Enrolled

5555 RESERVOIR DR STE 309, SAN DIEGO, CA 92120(619) 622-5261 Get Directions Write a Review

NPPES record last updated: June 5, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 5, 2024, Sep 30, 2019, Feb 23, 2017 and 1 more (4 updates tracked since 2017).

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About Bertha Alicia Bautista Lmft NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BERTHA ALICIA BAUTISTA LMFT (NPI 1093251001) is an individual marriage & family therapist in San Diego, California, licensed in California (127869) and active in the NPI registry since January 2017. She is enrolled in Medicare PECOS and maintains a secondary practice location in San Diego.

NPPES Registry Identity

NPI1093251001

Entity TypeIndividualFemale

Primary Taxonomy106H00000X

Provider Legal NameBERTHA ALICIA BAUTISTACredential: LMFT

Location Address5555 RESERVOIR DR STE 309San Diego, CA 92120-5193

Mailing Address941 Caleb CtSan Diego, CA 92154-2306 · (619) 622-5261

Phone(619) 622-5261

Sole ProprietorYes

Enumeration DateJanuary 13, 2017

Last NPPES UpdateJune 5, 20244 updates tracked since enumeration

NPPES CertifiedJune 5, 2024

✔ NPI 1093251001 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMarriage & Family TherapistBehavioral Health & Social Service Providers

Taxonomy Code106H00000X

License✔ Licensed in CA · 127869

Definition

A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups.

5555 RESERVOIR DR STE 309, San Diego, CA 92120

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Secondary Practice Location 1

Location 1941 Caleb CtSan Diego, CA 92154-2306 · Phone (619) 622-5261

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Bertha Alicia Bautista Lmft is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TRENISS MARIE ROBERTS

Marriage & Family Therapist