Provider Demographics
NPI:1386487635
Name:BATISTA, FAUSTO
Entity type:Individual
Prefix:
First Name:FAUSTO
Middle Name:
Last Name:BATISTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14108 SW 168TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2099
Mailing Address - Country:US
Mailing Address - Phone:786-617-0776
Mailing Address - Fax:
Practice Address - Street 1:10300 SW 72ND ST STE 333
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3019
Practice Address - Country:US
Practice Address - Phone:305-279-9255
Practice Address - Fax:305-279-9258
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT20-129776106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician