Healthcare Provider Details

I. General information

NPI: 1366269250
Provider Name (Legal Business Name): YAZAIRA BAEZ RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CASTELLANA GARDENS 32 EE1
CAROLINA PR
00983
US

IV. Provider business mailing address

CASTELLANA GARDENS 32 EE1
CAROLINA PR
00983
US

V. Phone/Fax

Practice location:
  • Phone: 787-237-0235
  • Fax:
Mailing address:
  • Phone: 787-237-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number3613
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3613
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number3513
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: