Provider Demographics
NPI:1689893182
Name:BAEZ ORTHOPAEDICS AND JOINT INSTITUTE, PSC
Entity Type:Organization
Organization Name:BAEZ ORTHOPAEDICS AND JOINT INSTITUTE, PSC
Other - Org Name:PROFFESIONAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MR
Authorized Official - First Name:NORBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-805-4949
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-1019
Mailing Address - Country:US
Mailing Address - Phone:787-831-0181
Mailing Address - Fax:787-805-4949
Practice Address - Street 1:AVE HOSTOS # 770
Practice Address - Street 2:POLICLINICA BELLA VISTA SUITE 104
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6353
Practice Address - Country:US
Practice Address - Phone:787-831-0181
Practice Address - Fax:787-805-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13550302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH81138Medicare UPIN
PR90354Medicare ID - Type UnspecifiedPROVIDER NUMBER OF MEDICA