Healthcare Provider Details

I. General information

NPI: 1558502690
Provider Name (Legal Business Name): R. SONIA BATRA, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 10/15/2023
Certification Date: 10/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 SANTA MONICA BLVD STE 101
SANTA MONICA CA
90404-2316
US

IV. Provider business mailing address

2216 SANTA MONICA BLVD STE 101
SANTA MONICA CA
90404-2316
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-9099
  • Fax: 310-828-9199
Mailing address:
  • Phone: 310-829-9099
  • Fax: 310-828-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA75794
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA75794
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA75794
License Number StateCA

VIII. Authorized Official

Name: RITU BATRA
Title or Position: MD
Credential: MD
Phone: 310-829-9099