Healthcare Provider Details

I. General information

NPI: 1689893182
Provider Name (Legal Business Name): BAEZ ORTHOPAEDICS AND JOINT INSTITUTE, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE HOSTOS # 770 POLICLINICA BELLA VISTA SUITE 104
MAYAGUEZ PR
00682-6353
US

IV. Provider business mailing address

PO BOX 1019
SABANA GRANDE PR
00637-1019
US

V. Phone/Fax

Practice location:
  • Phone: 787-831-0181
  • Fax: 787-805-4949
Mailing address:
  • Phone: 787-831-0181
  • Fax: 787-805-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number13550
License Number StatePR

VIII. Authorized Official

Name: MR. NORBERTO BAEZ
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-805-4949