Provider Demographics
NPI:1871357145
Name:BATUNGBACAL, JOSE ROBERT T III
Entity type:Individual
Prefix:
First Name:JOSE ROBERT
Middle Name:T
Last Name:BATUNGBACAL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 E FLAMINGO RD STE H
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5208
Mailing Address - Country:US
Mailing Address - Phone:725-251-3854
Mailing Address - Fax:
Practice Address - Street 1:2950 E FLAMINGO RD STE H
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5208
Practice Address - Country:US
Practice Address - Phone:725-251-3854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274706163WH0200X
UT11199674-3102163WH0200X
NVRN66012163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health