Provider Demographics
NPI:1184667347
Name:BAEZ, WANDA IVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:WANDA
Middle Name:IVETTE
Last Name:BAEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 9 BOX 5845
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-9629
Mailing Address - Country:US
Mailing Address - Phone:787-812-3030
Mailing Address - Fax:787-651-4321
Practice Address - Street 1:VA PONCE OUTPATIENT CLINIC
Practice Address - Street 2:1010 PASEO DEL VETERANO AVE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-812-3030
Practice Address - Fax:787-651-4321
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist