Provider Demographics
NPI:1043269608
Name:BATONGMALAQUE MEDICAL CORPORATION
Entity type:Organization
Organization Name:BATONGMALAQUE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BATONGMALAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-760-9538
Mailing Address - Street 1:11631 VICTORY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3572
Mailing Address - Country:US
Mailing Address - Phone:818-760-9538
Mailing Address - Fax:818-760-9539
Practice Address - Street 1:11631 VICTORY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3572
Practice Address - Country:US
Practice Address - Phone:818-760-9538
Practice Address - Fax:818-760-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3728213ES0103X
CAPT15084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT15084AMedicare ID - Type UnspecifiedPT
CAWE3728AMedicare ID - Type UnspecifiedDPM
CAW17079Medicare ID - Type UnspecifiedGROUP
CAWPT8628AMedicare ID - Type UnspecifiedPT
CAWC3852AMedicare ID - Type UnspecifiedM.D.