Healthcare Provider Details

I. General information

NPI: 1417080565
Provider Name (Legal Business Name): EDGAR A BATISTA MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 NW 53RD ST STE 108
DORAL FL
33166-4681
US

IV. Provider business mailing address

7950 NW 53RD ST STE 108
DORAL FL
33166-4681
US

V. Phone/Fax

Practice location:
  • Phone: 305-499-4200
  • Fax: 855-420-6315
Mailing address:
  • Phone: 305-499-4200
  • Fax: 855-420-6315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME-89120
License Number StateFL

VIII. Authorized Official

Name: DR. EDGAR ARTURO BATISTA
Title or Position: OWNER
Credential: MD
Phone: 305-499-4200