Healthcare Provider Details

I. General information

NPI: 1609091909
Provider Name (Legal Business Name): JULISSA BAEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E 12TH ST UNIT 1G
NEW YORK NY
10003-9151
US

IV. Provider business mailing address

2306 ESPLANADE AVE
BRONX NY
10469-5408
US

V. Phone/Fax

Practice location:
  • Phone: 646-524-6351
  • Fax: 646-524-6362
Mailing address:
  • Phone: 347-275-2030
  • Fax: 347-275-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number232901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: