Provider Demographics
NPI:1992584106
Name:CRYPTO MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:CRYPTO MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BATISTA
Authorized Official - Suffix:
Authorized Official - Credentials:RT (R)
Authorized Official - Phone:305-589-1494
Mailing Address - Street 1:3100 NW 72ND AVE STE 113A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1351
Mailing Address - Country:US
Mailing Address - Phone:305-589-1494
Mailing Address - Fax:
Practice Address - Street 1:3100 NW 72ND AVE STE 113A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1351
Practice Address - Country:US
Practice Address - Phone:305-589-1494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center