MEDICARE: KATHLEEN BATENGA RDHAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	HAP682	CA

General Provider Information

NPI Number	:	1952876138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN BATENGA RDHAP

Provider Business Mailing Address
First Line	:	6253 AVENIDA DE LAS VISTAS UNIT 1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-6619
Country	:	US
Telephone Number	:	619-316-6775
Fax Number	:

Provider Business Practice Location Address
First Line	:	6253 AVENIDA DE LAS VISTAS UNIT 1
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-6619
Country	:	US
Telephone Number	:	619-316-6775
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2018
Last Update Date	:	10/03/2018

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