Healthcare Provider Details

I. General information

NPI: 1316866205
Provider Name (Legal Business Name): ABDIEL OMAR BAEZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALTURAS DE SAN PEDRO CALLE SAN MARTIN P35
FAJARDO PR
00738
US

IV. Provider business mailing address

ALTURAS DE SAN PEDRO CALLE SAN MARTIN P35
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-1800
  • Fax:
Mailing address:
  • Phone: 787-757-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number104888
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: