Healthcare Provider Details

I. General information

NPI: 1588257554
Provider Name (Legal Business Name): KARLA BATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4129 GAGE AVE
BELL CA
90201-1128
US

IV. Provider business mailing address

635 SPRINGBROOK N
IRVINE CA
92614-7567
US

V. Phone/Fax

Practice location:
  • Phone: 626-457-5515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: