Provider Demographics
NPI:1750329793
Name:BAEZ, MARIA E (OMD DIPL OM LAC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:BAEZ
Suffix:
Gender:F
Credentials:OMD DIPL OM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 W 7TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3523
Mailing Address - Country:US
Mailing Address - Phone:310-547-2197
Mailing Address - Fax:
Practice Address - Street 1:1428 W 7TH ST STE B
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3523
Practice Address - Country:US
Practice Address - Phone:310-547-2197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27614111N00000X
CAAC10137171100000X
CAAC 10137171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor