Healthcare Provider Details

I. General information

NPI: 1821056011
Provider Name (Legal Business Name): RENE BAEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 BYPASS AVE.
PONCE PR
00717-1318
US

IV. Provider business mailing address

PO BOX 9570
CAGUAS PR
00726-9570
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-8686
  • Fax:
Mailing address:
  • Phone: 787-840-8686
  • Fax: 787-259-7364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number12593
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: