Provider Demographics
NPI:1114024874
Name:BATO, MARY THERESA (MSN, ACNPC, RN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:THERESA
Last Name:BATO
Suffix:
Gender:F
Credentials:MSN, ACNPC, RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1459 E BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3870
Mailing Address - Country:US
Mailing Address - Phone:909-794-3965
Mailing Address - Fax:
Practice Address - Street 1:11201 BENTON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-1000
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-583-6709
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA515618163W00000X
CA14380363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse