Provider Demographics
NPI:1417914193
Name:BATARSE, RODOLFO R (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:R
Last Name:BATARSE
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 1:71511 HIGHWAY 111
Mailing Address - Street 2:SUITE H
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4465
Mailing Address - Country:US
Mailing Address - Phone:760-773-2200
Mailing Address - Fax:760-773-2202
Practice Address - Street 1:71511 HIGHWAY 111
Practice Address - Street 2:SUITE H
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4465
Practice Address - Country:US
Practice Address - Phone:760-773-2200
Practice Address - Fax:760-773-2202
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74778207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A747780Medicaid
CA00A747780Medicaid
CAWA74778EMedicare ID - Type Unspecified
CAFF554AMedicare PIN