Provider Demographics
NPI:1174638373
Name:BATRES, ERIC (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BATRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 FLORENCE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3801
Mailing Address - Country:US
Mailing Address - Phone:323-560-4673
Mailing Address - Fax:323-560-3374
Practice Address - Street 1:5101 FLORENCE AVE STE 4
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-3801
Practice Address - Country:US
Practice Address - Phone:323-560-4673
Practice Address - Fax:323-560-3374
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G447260Medicaid
CA00G447260Medicaid
CAW17001Medicare ID - Type Unspecified
CAA49731Medicare UPIN