Healthcare Provider Details

I. General information

NPI: 1114752797
Provider Name (Legal Business Name): BEATRIZ BAEZA NORIEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 MANN DR
MATTHEWS NC
28105-5512
US

IV. Provider business mailing address

2007 ARIA VILLAGE DR APT 205
MATTHEWS NC
28104-1445
US

V. Phone/Fax

Practice location:
  • Phone: 704-255-5354
  • Fax:
Mailing address:
  • Phone: 704-776-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-357609
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: