Provider Demographics
NPI:1851683197
Name:BAEZ, IXAYAN
Entity Type:Individual
Prefix:MS
First Name:IXAYAN
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:IXAYANNE
Other - Middle Name:
Other - Last Name:BAEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:390 40TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2633
Mailing Address - Country:US
Mailing Address - Phone:510-613-0330
Mailing Address - Fax:
Practice Address - Street 1:508 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4446
Practice Address - Country:US
Practice Address - Phone:707-515-7186
Practice Address - Fax:888-437-1193
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
CA104300106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator