Provider Demographics
NPI:1477614139
Name:BAEZ-ROJAS, EVELYN R (PHD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:R
Last Name:BAEZ-ROJAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36203 LAKE UNITY NURSERY RD
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-5818
Mailing Address - Country:US
Mailing Address - Phone:352-323-1748
Mailing Address - Fax:
Practice Address - Street 1:1799 SALK AVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4311
Practice Address - Country:US
Practice Address - Phone:352-742-8300
Practice Address - Fax:352-742-8305
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4794103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59515OtherBLUE CROSS AND BLUE SHIEL
FL59515AMedicare ID - Type Unspecified