Provider Demographics
NPI:1699821538
Name:BAEZ, GLENDA LILLIANA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:LILLIANA
Last Name:BAEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3800
Mailing Address - Country:US
Mailing Address - Phone:619-799-8031
Mailing Address - Fax:866-275-1761
Practice Address - Street 1:2801 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 211
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3800
Practice Address - Country:US
Practice Address - Phone:619-799-8031
Practice Address - Fax:866-275-1761
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist