Healthcare Provider Details

I. General information

NPI: 1326871757
Provider Name (Legal Business Name): WHITNEY R BATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 W 4TH ST
SAN BERNARDINO CA
92410
US

IV. Provider business mailing address

604 W 4TH ST
SAN BERNARDINO CA
92410-3216
US

V. Phone/Fax

Practice location:
  • Phone: 909-402-8211
  • Fax:
Mailing address:
  • Phone: 909-402-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number207QA0401X
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: