Provider Demographics
NPI:1578710174
Name:BATISTA, GUSTAVO ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:ALBERTO
Last Name:BATISTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 S DOUGLAS RD
Mailing Address - Street 2:PH 4
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-7510
Mailing Address - Country:US
Mailing Address - Phone:786-310-0383
Mailing Address - Fax:
Practice Address - Street 1:8212 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2028
Practice Address - Country:US
Practice Address - Phone:305-521-8740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437688207R00000X
VA0116023871390200000X, 207RI0200X
FLME 122962207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program