Provider Demographics
NPI:1245371210
Name:BATALLA, PERFECTO G JR (PT)
Entity type:Individual
Prefix:
First Name:PERFECTO
Middle Name:G
Last Name:BATALLA
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16377 LAS CUMBRES DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-1139
Mailing Address - Country:US
Mailing Address - Phone:562-943-9559
Mailing Address - Fax:562-943-7518
Practice Address - Street 1:6301 BEACH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-4030
Practice Address - Country:US
Practice Address - Phone:714-404-6863
Practice Address - Fax:714-994-8090
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66236ZOtherBLUE CROSS BLUE SHIELD
CAZZZ66236ZOtherBLUE CROSS BLUE SHIELD
CAQ49017Medicare UPIN