Provider Demographics
NPI:1235173550
Name:CLINICAL GENETICS ASSOCIATES, MDPA
Entity Type:Organization
Organization Name:CLINICAL GENETICS ASSOCIATES, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BATISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-663-8595
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-663-8595
Mailing Address - Fax:305-669-6443
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-663-8595
Practice Address - Fax:305-669-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41628174400000X
FLME66723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID