Provider Demographics
NPI:1497776108
Name:OFICINA DE OFTALMOLOGIA DR EMILIO A BAEZ RIVERA, CSP
Entity Type:Organization
Organization Name:OFICINA DE OFTALMOLOGIA DR EMILIO A BAEZ RIVERA, CSP
Other - Org Name:OFICINA DE OFTALMOLOGIA DR EMILIO A BAEZ RIVERA, CSP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:V
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-314-2929
Mailing Address - Street 1:PO BOX 4952
Mailing Address - Street 2:PMB 580
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4952
Mailing Address - Country:US
Mailing Address - Phone:787-258-2237
Mailing Address - Fax:787-747-0964
Practice Address - Street 1:81 AVE LUIS MUNOZ MARIN STE 201
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3883
Practice Address - Country:US
Practice Address - Phone:787-258-2237
Practice Address - Fax:787-747-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR013195207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085403Medicare PIN
PRH97752Medicare UPIN