Basic Information
| Provider Information | |||||||||
| NPI: | 1114024874 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BATO | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | THERESA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSN, ACNPC, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1459 E BROCKTON AVE | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923743870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097943965 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11201 BENTON ST | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923571000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098257084 | ||||||||
| FaxNumber: | 9095836709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2006 | ||||||||
| LastUpdateDate: | 10/07/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 515618 | CA | N | Nursing Service Providers | Registered Nurse | 363LA2100X | 14380 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.