Provider Demographics
NPI:1528213253
Name:BAEZ, JOSE (LO)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:BAEZ
Suffix:
Gender:M
Credentials:LO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HR22 VIA 15
Mailing Address - Street 2:VILLA FONTANA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3921
Mailing Address - Country:US
Mailing Address - Phone:939-244-9517
Mailing Address - Fax:
Practice Address - Street 1:HR22 VIA 15
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3921
Practice Address - Country:US
Practice Address - Phone:939-244-9517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR480156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician