Provider Demographics
NPI:1972366995
Name:BATTUNG, RAE JUSTINE FRANCO
Entity type:Individual
Prefix:
First Name:RAE JUSTINE
Middle Name:FRANCO
Last Name:BATTUNG
Suffix:
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 1:1481 N. WINDSOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNADINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404
Mailing Address - Country:US
Mailing Address - Phone:909-361-6470
Mailing Address - Fax:
Practice Address - Street 1:1481 N. WINDSOR DRIVE
Practice Address - Street 2:1481 N. WINDSOR DRIVE
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5416
Practice Address - Country:US
Practice Address - Phone:909-361-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA714167164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse