Provider Demographics
NPI:1881803328
Name:BAQUERO, NITZA M (MA)
Entity type:Individual
Prefix:MRS
First Name:NITZA
Middle Name:M
Last Name:BAQUERO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-0280
Mailing Address - Country:US
Mailing Address - Phone:787-647-2930
Mailing Address - Fax:
Practice Address - Street 1:180 AVE WINSTON CHURCHILL
Practice Address - Street 2:CROWN HILL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6013
Practice Address - Country:US
Practice Address - Phone:787-647-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1750103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist