Provider Demographics
NPI:1255765681
Name:BAEZ, RICARDO LUIS (PA)
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:LUIS
Last Name:BAEZ
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:2125 RANDALL AVENUE
Mailing Address - Street 2:APT. 6M
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473
Mailing Address - Country:US
Mailing Address - Phone:347-853-0915
Mailing Address - Fax:
Practice Address - Street 1:49 LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1889
Practice Address - Country:US
Practice Address - Phone:315-274-9075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016861363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical