Provider Demographics
NPI:1912038720
Name:BAEZ, EDNEE LIMARYS
Entity Type:Individual
Prefix:
First Name:EDNEE
Middle Name:LIMARYS
Last Name:BAEZ
Suffix:
Gender:F
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 263
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-0263
Mailing Address - Country:US
Mailing Address - Phone:787-672-3985
Mailing Address - Fax:787-893-3984
Practice Address - Street 1:52 CALLE CRISTOBAL COLON
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-3340
Practice Address - Country:US
Practice Address - Phone:787-672-3985
Practice Address - Fax:787-893-3984
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4999183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4999OtherPHARMACY ASSISTANT