Healthcare Provider Details

I. General information

NPI: 1306493267
Provider Name (Legal Business Name): ZADE NEIL BATARSEH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 03/07/2023
Certification Date: 10/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 ERRINGER RD
SIMI VALLEY CA
93065-2352
US

IV. Provider business mailing address

5720 RALSTON ST STE 200
VENTURA CA
93003-7844
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-1404
  • Fax: 805-527-5246
Mailing address:
  • Phone: 805-804-4168
  • Fax: 805-830-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number56971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: