Provider Demographics
NPI:1952350613
Name:BATONGMALAQUE, JENNY L (MD)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:L
Last Name:BATONGMALAQUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23251 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-5229
Mailing Address - Country:US
Mailing Address - Phone:310-830-4561
Mailing Address - Fax:310-830-0210
Practice Address - Street 1:23251 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-5229
Practice Address - Country:US
Practice Address - Phone:310-830-4561
Practice Address - Fax:310-830-0210
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23563173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA23481AMedicare ID - Type Unspecified