Provider Demographics
NPI:1174684153
Name:BAEZ-QUINONES, SAMARA
Entity Type:Individual
Prefix:DR
First Name:SAMARA
Middle Name:
Last Name:BAEZ-QUINONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND JARDINES DE MONTEHIEDRA 1500
Mailing Address - Street 2:APTO 801
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-458-6177
Mailing Address - Fax:
Practice Address - Street 1:1715 AVE PONCE DE LEON
Practice Address - Street 2:STE S1
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1966
Practice Address - Country:US
Practice Address - Phone:787-458-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15532208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice