Provider Demographics
NPI:1275605990
Name:BAEZ - MARIN, CARLOS R (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:R
Last Name:BAEZ - MARIN
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 2008
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-2008
Mailing Address - Country:US
Mailing Address - Phone:787-505-4775
Mailing Address - Fax:787-621-3319
Practice Address - Street 1:DOCTORS' CENTER HOSPITAL, MEDICINA ESPECIALIZADA BLDG.
Practice Address - Street 2:ROAD #2 KM. 47.7
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0000
Practice Address - Country:US
Practice Address - Phone:787-621-3378
Practice Address - Fax:787-621-3319
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11752207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG97487Medicare UPIN