Healthcare Provider Details

I. General information

NPI: 1235115825
Provider Name (Legal Business Name): SANTIAGO BAEZ-TORRES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO SUITE 623
PONCE PR
00716-4728
US

IV. Provider business mailing address

909 AVE TITO CASTRO SUITE 623
PONCE PR
00716-4728
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-0909
  • Fax: 787-812-0920
Mailing address:
  • Phone: 787-812-0909
  • Fax: 787-812-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number11474
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: