Healthcare Provider Details

I. General information

NPI: 1558453258
Provider Name (Legal Business Name): ANJAN SINGH BATRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE 750
ORANGE CA
92868-4225
US

IV. Provider business mailing address

1140 W LA VETA AVE STE 750
ORANGE CA
92868-4217
US

V. Phone/Fax

Practice location:
  • Phone: 714-581-4401
  • Fax: 714-581-4420
Mailing address:
  • Phone: 714-581-4401
  • Fax: 714-581-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberA61838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: