Provider Demographics
NPI:1083869358
Name:BAEZ, AUREALIS T (MPH)
Entity Type:Individual
Prefix:DR
First Name:AUREALIS
Middle Name:T
Last Name:BAEZ
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CALLE MARACAIBO # URB
Mailing Address - Street 2:20 GLORIMAR ST.
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2234
Mailing Address - Country:US
Mailing Address - Phone:787-790-1300
Mailing Address - Fax:
Practice Address - Street 1:100 CALLE MARACAIBO # URB
Practice Address - Street 2:20 GLORIMAR ST.
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2234
Practice Address - Country:US
Practice Address - Phone:787-790-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2008-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1251103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical