Provider Demographics
NPI:1780811836
Name:BAEZ, JAMAR ALEXIS
Entity type:Individual
Prefix:MR
First Name:JAMAR
Middle Name:ALEXIS
Last Name:BAEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVENIDA TITO CASTRO 609
Mailing Address - Street 2:SUITE 102 PMB 183
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2232
Mailing Address - Country:US
Mailing Address - Phone:787-385-6886
Mailing Address - Fax:
Practice Address - Street 1:HACIENDA DEL CAYABO
Practice Address - Street 2:P#102 PMB 183
Practice Address - City:JUANA DIA
Practice Address - State:PR
Practice Address - Zip Code:00795
Practice Address - Country:US
Practice Address - Phone:787-374-7262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1635146L00000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic