Provider Demographics
NPI:1598027427
Name:JUAN E. BATISTA #2
Entity Type:Organization
Organization Name:JUAN E. BATISTA #2
Other - Org Name:JUAN E. BATISTA #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMPARO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-433-0080
Mailing Address - Street 1:4623 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-9121
Mailing Address - Country:US
Mailing Address - Phone:561-433-0080
Mailing Address - Fax:561-433-1668
Practice Address - Street 1:4623 FOREST HILL BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-9121
Practice Address - Country:US
Practice Address - Phone:561-433-0080
Practice Address - Fax:561-433-1668
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUAN E. BATISTA, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-15
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109755261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271119201Medicaid