Provider Demographics
NPI:1740572007
Name:BAEZ, JULIO RUBEN III (HS3)
Entity Type:Individual
Prefix:MR
First Name:JULIO
Middle Name:RUBEN
Last Name:BAEZ
Suffix:III
Gender:M
Credentials:HS3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 L STREET
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00603
Mailing Address - Country:UM
Mailing Address - Phone:787-890-8477
Mailing Address - Fax:
Practice Address - Street 1:260 GUARD RD.
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00603
Practice Address - Country:UM
Practice Address - Phone:787-890-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA247200000X
CAB1960369146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other