Provider Demographics
NPI:1578952339
Name:BAEZ LOPEZ, KATIUSKA NIKOLE (MD)
Entity Type:Individual
Prefix:
First Name:KATIUSKA
Middle Name:NIKOLE
Last Name:BAEZ LOPEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TORRE CIBELES II
Mailing Address - Street 2:APT 522
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3995
Mailing Address - Country:US
Mailing Address - Phone:787-393-8400
Mailing Address - Fax:
Practice Address - Street 1:596 CALLE CESAR GONZALEZ
Practice Address - Street 2:APT 522
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4348
Practice Address - Country:US
Practice Address - Phone:787-393-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19846207Q00000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine