Provider Demographics
NPI:1518424233
Name:BATESON, JAMESINA LUSAL (NP)
Entity Type:Individual
Prefix:
First Name:JAMESINA
Middle Name:LUSAL
Last Name:BATESON
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 1:20 VITTORIA ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-8834
Mailing Address - Country:US
Mailing Address - Phone:760-887-3482
Mailing Address - Fax:
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 281
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-7302
Practice Address - Country:US
Practice Address - Phone:949-364-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily