Provider Demographics
NPI:1639524796
Name:BAEZA HASBUN, GABRIEL ANIBAL (CRDH)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ANIBAL
Last Name:BAEZA HASBUN
Suffix:
Gender:M
Credentials:CRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5224 44TH ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-4022
Mailing Address - Country:US
Mailing Address - Phone:941-243-8576
Mailing Address - Fax:
Practice Address - Street 1:5868 14TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4027
Practice Address - Country:US
Practice Address - Phone:941-251-5924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH23541124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist