Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 53695 | CA |
NPI | 1073783650 |
---|---|
Provider Name | Tricia David Bato |
First Address | Walnut, CA 91789-4234 |
Second Address | Mission Viejo, CA 92691-6384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2008 |
Last Update Date | 02/12/2009 |