Provider Demographics
NPI:1922386812
Name:BAQUERIZO, JULIO C (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:JULIO
Middle Name:C
Last Name:BAQUERIZO
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Gender:M
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:10 GREEN ST
Mailing Address - Street 2:UNIT# 4 - 217
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095
Mailing Address - Country:US
Mailing Address - Phone:732-882-2573
Mailing Address - Fax:732-324-1876
Practice Address - Street 1:10 GREEN ST
Practice Address - Street 2:UNIT# 4 - 217
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095
Practice Address - Country:US
Practice Address - Phone:732-882-2573
Practice Address - Fax:732-324-1876
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2023-05-01
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00336100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0330574Medicaid