Provider Demographics
NPI:1184981516
Name:BAEZ, BENIGNO (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:BENIGNO
Middle Name:
Last Name:BAEZ
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE GANDARA 32A
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-2059
Mailing Address - Country:US
Mailing Address - Phone:787-859-1042
Mailing Address - Fax:
Practice Address - Street 1:CALLE GANDARA 32A
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-2059
Practice Address - Country:US
Practice Address - Phone:787-859-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR010156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician