Provider Demographics
NPI:1225014434
Name:BAEZ, EDGARD CRUZ (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARD
Middle Name:CRUZ
Last Name:BAEZ
Suffix:
Gender:M
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:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0352
Mailing Address - Country:US
Mailing Address - Phone:787-259-1719
Mailing Address - Fax:
Practice Address - Street 1:2669 AVE LAS AMERICAS
Practice Address - Street 2:URB CONSTANCIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2106
Practice Address - Country:US
Practice Address - Phone:787-259-1719
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10957174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG37200Medicare UPIN