Provider Demographics
NPI:1790170157
Name:BAEZ CLASS, YARITZA ENID (PT)
Entity Type:Individual
Prefix:MRS
First Name:YARITZA
Middle Name:ENID
Last Name:BAEZ CLASS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 CALLE CAUNABO
Mailing Address - Street 2:URB. COLINAS DE BAYOAN
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-3771
Mailing Address - Country:US
Mailing Address - Phone:787-501-8807
Mailing Address - Fax:
Practice Address - Street 1:102 CALLE CAUNABO
Practice Address - Street 2:URB. COLINAS DE BAYOAN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-3771
Practice Address - Country:US
Practice Address - Phone:787-501-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1410OtherSTATE LICENSE