Basic Information
| Provider Information | |||||||||
| NPI: | 1245371210 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BATALLA | ||||||||
| FirstName: | PERFECTO | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16377 LAS CUMBRES DR | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906031139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629439559 | ||||||||
| FaxNumber: | 5629437518 | ||||||||
| Practice Location | |||||||||
| Address1: | 6301 BEACH BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906214030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144046863 | ||||||||
| FaxNumber: | 7149948090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT17004 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | ZZZ66236Z | 01 | CA | BLUE CROSS BLUE SHIELD | OTHER |