Healthcare Provider Details

I. General information

NPI: 1306383328
Provider Name (Legal Business Name): TIANNE BATISTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2017
Last Update Date: 01/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5740 W CENTINELA AVE APT 309
LOS ANGELES CA
90045-8826
US

IV. Provider business mailing address

5740 W CENTINELA AVE APT 309
LOS ANGELES CA
90045-8826
US

V. Phone/Fax

Practice location:
  • Phone: 323-403-3264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number11156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: