Healthcare Provider Details

I. General information

NPI: 1629010327
Provider Name (Legal Business Name): CASEY GRANT BATTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 RANCHO CONEJO BLVD
THOUSAND OAKS CA
91320-1718
US

IV. Provider business mailing address

2222 BANCROFT WAY
BERKELEY CA
94720-4300
US

V. Phone/Fax

Practice location:
  • Phone: 310-665-7200
  • Fax: 888-835-0943
Mailing address:
  • Phone: 510-643-5808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD40312
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA96253
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA96253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: