Provider Demographics
NPI:1801372891
Name:BAEZ SANCHEZ, ELAN RAYAN
Entity Type:Individual
Prefix:
First Name:ELAN
Middle Name:RAYAN
Last Name:BAEZ SANCHEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 94000
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-9481
Mailing Address - Country:US
Mailing Address - Phone:787-359-6904
Mailing Address - Fax:
Practice Address - Street 1:951 CARR 891 STE 201
Practice Address - Street 2:PLAZA DEL CARMEN
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-359-6904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1353156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty