1649682600 NPI number — MISS ALBA Y. BAEZ

Table of content: MISS ALBA Y. BAEZ (NPI 1649682600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649682600 NPI number — MISS ALBA Y. BAEZ

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAEZ
Provider First Name:
ALBA
Provider Middle Name:
Y.
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAEZ
Provider Other First Name:
ALBA
Provider Other Middle Name:
Y.
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1649682600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COND. VISTA REAL II
Provider Second Line Business Mailing Address:
Q-139
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PUERTO RICO
Provider Business Mailing Address Postal Code:
00725
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
787-220-8899
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VISTA REAL II
Provider Second Line Business Practice Location Address:
Q-139
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-220-8899
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2099 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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