Provider Demographics
NPI:1538958715
Name:GONZALEZ BATEN, GLENDY LETICIA
Entity type:Individual
Prefix:
First Name:GLENDY
Middle Name:LETICIA
Last Name:GONZALEZ BATEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10440 QUILL AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-3020
Mailing Address - Country:US
Mailing Address - Phone:818-588-1082
Mailing Address - Fax:
Practice Address - Street 1:10440 QUILL AVE APT 109
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-3020
Practice Address - Country:US
Practice Address - Phone:818-588-1082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program