Provider Demographics
NPI:1639144918
Name:BAEZ CHAO, PABLO J (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:J
Last Name:BAEZ CHAO
Suffix:
Gender:M
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:VILLANOVA
Mailing Address - Street 2:#F1-25 CALLE C
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-274-0527
Mailing Address - Fax:787-764-7963
Practice Address - Street 1:CARR 129 KM 8-5
Practice Address - Street 2:BO CAMPO ALEGRE
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00614
Practice Address - Country:US
Practice Address - Phone:787-817-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11724174400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G41671Medicare UPIN
PR87645Medicare ID - Type Unspecified