MEDICARE: DR. AUREALIS T BAEZ MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1251	PR

General Provider Information

NPI Number	:	1083869358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUREALIS T BAEZ MPH

Provider Business Mailing Address
First Line	:	100 CALLE MARACAIBO # URB
Second Line	:	20 GLORIMAR ST.
City	:	SAN JUAN
State	:	PR
Zip	:	00926-2234
Country	:	US
Telephone Number	:	787-790-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CALLE MARACAIBO # URB
Second Line	:	20 GLORIMAR ST.
City	:	SAN JUAN
State	:	PR
Zip	:	00926-2234
Country	:	US
Telephone Number	:	787-790-1300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2008
Last Update Date	:	11/29/2008

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