Provider Demographics
NPI:1326198144
Name:BATRA, AMIT (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:BATRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W AVENIDA VISTA HERMOSA STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-7707
Mailing Address - Country:US
Mailing Address - Phone:408-665-3726
Mailing Address - Fax:
Practice Address - Street 1:101 W AVENIDA VISTA HERMOSA STE 120
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672
Practice Address - Country:US
Practice Address - Phone:408-665-3726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74555207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A745550Medicaid
CA00A745550Medicaid
I01992Medicare UPIN