Provider Demographics
NPI:1417210774
Name:BATHAN, MERLINDA MACALINTAL (NP)
Entity Type:Individual
Prefix:
First Name:MERLINDA
Middle Name:MACALINTAL
Last Name:BATHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 SHADY GLEN LN
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4154
Mailing Address - Country:US
Mailing Address - Phone:909-824-5413
Mailing Address - Fax:
Practice Address - Street 1:2509 SHADY GLEN LN
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4154
Practice Address - Country:US
Practice Address - Phone:909-824-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21634363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner