MEDICARE: MRS. YARITZA ENID BAEZ CLASS PT

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	225100000X	Physical Therapist	1410	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1410	OTHER	PR	STATE LICENSE

General Provider Information

NPI Number	:	1790170157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YARITZA ENID BAEZ CLASS PT

Provider Business Mailing Address
First Line	:	PO BOX 364189
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-4189
Country	:	US
Telephone Number	:	787-767-6710
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 CALLE BAEZ
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-5020
Country	:	US
Telephone Number	:	787-767-6710
Fax Number	:

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

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	03/05/2026

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