Provider Demographics
NPI:1538503453
Name:BAEZ, JORGE Y
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:Y
Last Name:BAEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 S SEMORAN BLVD
Mailing Address - Street 2:BUILDING 2 SUITE 1013
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5526
Mailing Address - Country:US
Mailing Address - Phone:407-446-2272
Mailing Address - Fax:
Practice Address - Street 1:1035 S SEMORAN BLVD
Practice Address - Street 2:BUILDING 2 SUITE 1013
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5526
Practice Address - Country:US
Practice Address - Phone:407-446-2272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker