Provider Demographics
NPI:1649682600
Name:BAEZ, ALBA Y
Entity type:Individual
Prefix:MISS
First Name:ALBA
Middle Name:Y
Last Name:BAEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ALBA
Other - Middle Name:Y
Other - Last Name:BAEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:COND. VISTA REAL II
Mailing Address - Street 2:Q-139
Mailing Address - City:CAGUAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00725
Mailing Address - Country:UM
Mailing Address - Phone:787-220-8899
Mailing Address - Fax:
Practice Address - Street 1:VISTA REAL II
Practice Address - Street 2:Q-139
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-220-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2099Medicaid