=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689198061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BATAL MEDICAL, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2017
-----------------------------------------------------
Last Update Date | 07/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1041 E YORBA LINDA BLVD
-----------------------------------------------------
City | PLACENTIA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-823-3668
-----------------------------------------------------
Fax | 714-844-9198
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 150
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92815-0150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-704-8178
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. OBAIDA BATAL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-704-8178
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 140060
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------