Provider Demographics
NPI:1003936386
Name:BAESA, HILDA R (PA-C)
Entity Type:Individual
Prefix:
First Name:HILDA
Middle Name:R
Last Name:BAESA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843204
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-3204
Mailing Address - Country:US
Mailing Address - Phone:956-318-1129
Mailing Address - Fax:956-318-1178
Practice Address - Street 1:4302 S SUGAR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7073
Practice Address - Country:US
Practice Address - Phone:956-318-1129
Practice Address - Fax:956-318-1178
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00384363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX422895YKSJMedicare PIN