Provider Demographics
NPI:1376104349
Name:BAEZ ORTIZ, HANOC
Entity Type:Individual
Prefix:
First Name:HANOC
Middle Name:
Last Name:BAEZ ORTIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HANOC
Other - Middle Name:
Other - Last Name:BAEZ ORTIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:HC 4 BOX 17295
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-9525
Mailing Address - Country:US
Mailing Address - Phone:939-241-9639
Mailing Address - Fax:
Practice Address - Street 1:CALLE EL SOL CAR 3 INT 908
Practice Address - Street 2:BO AGUACATE
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:939-241-9639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2013235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist