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General NPI Number Information
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NPI Number | 1326304908
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Entity Type | Individual
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Provider Name | MAYA IRENE SRIMUSHNAM BATISTA M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/08/2012
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 5668 EDWARDS RANCH RD STE 101
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City | FORT WORTH
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State | TX
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Zip | 76109-4109
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Country | US
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Telephone | 817-764-1554
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Fax | 817-764-1565
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Provider Business Mailing Address
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Address Line | PO BOX 842861
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City | DALLAS
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State | TX
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Zip | 75284-2861
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Country | US
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Telephone | 817-764-1554
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Fax | 817-764-1565
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | R5651
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | R5651
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License Number State | TX
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