Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 308009 | NY |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 95011558 | CA |
NPI | 1013468149 |
---|---|
Provider Name | Jason Batalha |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010-3012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2016 |
Last Update Date | 28/10/2020 |