Provider Demographics
NPI:1457506222
Name:BAEZ, EMMA M
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:M
Last Name:BAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6580 W 27TH CT APT 14
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2868
Mailing Address - Country:US
Mailing Address - Phone:786-663-5531
Mailing Address - Fax:
Practice Address - Street 1:6580 W 27TH CT APT 14
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-2868
Practice Address - Country:US
Practice Address - Phone:786-663-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL642402696251E00000X
FLRBT-15-08450106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103687600Medicaid
FL692402696Medicaid