Provider Demographics
NPI:1982655809
Name:BATISTE, STAN M (MD)
Entity Type:Individual
Prefix:
First Name:STAN
Middle Name:M
Last Name:BATISTE
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2871
Mailing Address - Fax:916-853-4730
Practice Address - Street 1:3000 Q ST FL 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3301
Practice Address - Fax:916-281-3882
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV93972085R0202X
CAC526672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV9641OtherBCBS
NV200290115Medicaid
NV152968OtherWC
NV153106OtherWC
NVV33498Medicare PIN