Healthcare Provider Details

I. General information

NPI: 1437528247
Provider Name (Legal Business Name): GUSTAVO A BATISTA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N UNIVERSITY DR STE 207
PEMBROKE PINES FL
33024-3617
US

IV. Provider business mailing address

2301 N UNIVERSITY DR STE 207
PEMBROKE PINES FL
33024-3617
US

V. Phone/Fax

Practice location:
  • Phone: 954-641-8571
  • Fax:
Mailing address:
  • Phone: 954-641-8571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME122962
License Number StateFL

VIII. Authorized Official

Name: GUSTAVO ALBERTO BATISTA
Title or Position: OWNER
Credential:
Phone: 954-641-8571