Provider Demographics
NPI:1376079756
Name:BAEZA, KATHRYN ESTAYA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ESTAYA
Last Name:BAEZA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 FLORAL AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-2602
Mailing Address - Country:US
Mailing Address - Phone:559-896-7105
Mailing Address - Fax:
Practice Address - Street 1:2640 FLORAL AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-2602
Practice Address - Country:US
Practice Address - Phone:559-896-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80288183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist