Provider Demographics
NPI:1568774578
Name:BATARSEH, NISREEN Z
Entity Type:Individual
Prefix:
First Name:NISREEN
Middle Name:Z
Last Name:BATARSEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 LORENE CT
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-6002
Mailing Address - Country:US
Mailing Address - Phone:760-375-0223
Mailing Address - Fax:760-375-6733
Practice Address - Street 1:101 N CHINA LAKE BLVD
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-3915
Practice Address - Country:US
Practice Address - Phone:760-375-0223
Practice Address - Fax:760-375-6733
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist