Healthcare Provider Details

I. General information

NPI: 1053856898
Provider Name (Legal Business Name): RAFAEL BAEZ SANCHEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAFAEL DE JESUS BAEZ SANCHEZ M.D.

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CALLE FONT MARTELO W
HUMACAO PR
00791-3616
US

IV. Provider business mailing address

PO BOX 23
JUNCOS PR
00777-0023
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-1770
  • Fax: 787-266-7300
Mailing address:
  • Phone: 787-852-1770
  • Fax: 787-266-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number8804
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: