Provider Demographics
NPI:1386170249
Name:GUZMAN BATISTA, IRAIDA
Entity type:Individual
Prefix:
First Name:IRAIDA
Middle Name:
Last Name:GUZMAN BATISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 SW 137TH AVE STE 234
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6333
Mailing Address - Country:US
Mailing Address - Phone:305-381-5420
Mailing Address - Fax:305-381-5335
Practice Address - Street 1:2450 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-8802
Practice Address - Country:US
Practice Address - Phone:305-575-3800
Practice Address - Fax:305-381-5420
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9525059163W00000X
106S00000X
FLAPRN11022457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician