Healthcare Provider Details

I. General information

NPI: 1194794255
Provider Name (Legal Business Name): EDWIN BAEZ MONTALVO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE AGUAS BUENAS BLOQ 16 #34 URB SANTA ROSA
BAYAMON PR
00959
US

IV. Provider business mailing address

AVE AGUAS BUENAS BLOQ 16 #34 URB SANTA ROSA
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-0344
  • Fax: 787-740-4266
Mailing address:
  • Phone: 787-798-0344
  • Fax: 787-740-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number6417
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: