Healthcare Provider Details

I. General information

NPI: 1518973544
Provider Name (Legal Business Name): CHARLES R. BATTAGLIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST STE 103
PASADENA CA
91105-3027
US

IV. Provider business mailing address

547 EAST UNION STREET
PASADENA CA
91101
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-6164
  • Fax: 626-796-0883
Mailing address:
  • Phone: 626-796-6164
  • Fax: 626-769-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG16535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: