Provider Demographics
NPI:1396433207
Name:BATACLAN, KATRINA CREENCIA
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:CREENCIA
Last Name:BATACLAN
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 1:916 N AVENUE 57
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2637
Mailing Address - Country:US
Mailing Address - Phone:323-715-8467
Mailing Address - Fax:
Practice Address - Street 1:916 N AVENUE 57
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-2637
Practice Address - Country:US
Practice Address - Phone:323-715-8467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily