MEDICARE: JUAN E. BATISTA #2

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	ME109755	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598027427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUAN E. BATISTA #2

Provider Business Mailing Address
First Line	:	4623 FOREST HILL BLVD
Second Line	:	SUITE 112
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-9121
Country	:	US
Telephone Number	:	561-433-0080
Fax Number	:	561-433-1668

Provider Business Practice Location Address
First Line	:	4623 FOREST HILL BLVD
Second Line	:	SUITE 112
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-9121
Country	:	US
Telephone Number	:	561-433-0080
Fax Number	:	561-433-1668

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	AMPARO GONZALEZ
Credential	:
Telephone Number	:	561-433-0080

Provider Enumeration Date	:	06/15/2012
Last Update Date	:	10/11/2012

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Directions to “JUAN E. BATISTA #2 ” Practice Location

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