Healthcare Provider Details

I. General information

NPI: 1386170249
Provider Name (Legal Business Name): IRAIDA GUZMAN BATISTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 SW 137TH AVE
MIAMI FL
33175-8802
US

IV. Provider business mailing address

2450 SW 137TH AVE STE 234
MIAMI FL
33175-6333
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-3800
  • Fax: 305-381-5420
Mailing address:
  • Phone: 305-381-5420
  • Fax: 305-381-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9525059
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11022457
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: