Provider Demographics
NPI:1356303275
Name:BAEZ CORDOVA, JOSE A (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:BAEZ CORDOVA
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 1:14B CALLE VANDA
Mailing Address - Street 2:LOS FILTROS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-3151
Mailing Address - Country:US
Mailing Address - Phone:787-273-7969
Mailing Address - Fax:
Practice Address - Street 1:14B CALLE VANDA
Practice Address - Street 2:LOS FILTROS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-3151
Practice Address - Country:US
Practice Address - Phone:787-273-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12933208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR90169Medicare ID - Type Unspecified
PRH66203Medicare UPIN