Healthcare Provider Details

I. General information

NPI: 1790210573
Provider Name (Legal Business Name): ERIC KEI BATANGAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5355 WARNER AVE
HUNTINGTON BEACH CA
92649-4097
US

IV. Provider business mailing address

5355 WARNER AVE STE 102
HUNTINGTON BEACH CA
92649-6030
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-7470
  • Fax: 949-764-7471
Mailing address:
  • Phone: 949-764-7470
  • Fax: 949-764-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68303
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6092772
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: