Healthcare Provider Details

I. General information

NPI: 1083715742
Provider Name (Legal Business Name): JAIME L. BAQUERO, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7070 W PALMETTO PARK RD
BOCA RATON FL
33433-3411
US

IV. Provider business mailing address

7070 W PALMETTO PARK RD
BOCA RATON FL
33433-3411
US

V. Phone/Fax

Practice location:
  • Phone: 561-451-3481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAIME BAQUERO
Title or Position: OWNER
Credential:
Phone: 561-451-3481