Provider Demographics
NPI:1023212255
Name:BAEZ, MIREYDA (LND)
Entity Type:Individual
Prefix:MRS
First Name:MIREYDA
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB VILLAS DE SAN AGUSTIN
Mailing Address - Street 2:AVE SAN AGUSTIN D21
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-2040
Mailing Address - Country:US
Mailing Address - Phone:787-409-1929
Mailing Address - Fax:
Practice Address - Street 1:URB VILLAS DE SAN AGUSTIN
Practice Address - Street 2:AVE SAN AGUSTIN D21
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-2040
Practice Address - Country:US
Practice Address - Phone:787-409-1929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1339133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education