Provider Demographics
NPI:1386846269
Name:BAEZ, RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
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:STATE ROAD 787
Mailing Address - Street 2:KM 1.5, BAYAMON WARD
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1400
Mailing Address - Country:US
Mailing Address - Phone:787-739-5555
Mailing Address - Fax:787-739-5544
Practice Address - Street 1:STATE ROAD 787
Practice Address - Street 2:KM 1.5, BAYAMON WARD
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-1400
Practice Address - Country:US
Practice Address - Phone:787-739-5555
Practice Address - Fax:787-739-5544
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14,654208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice