Healthcare Provider Details

I. General information

NPI: 1700464559
Provider Name (Legal Business Name): OMAR ALEJANDRO SANTIAGO BAEZ MD, MPH, FAAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 07/22/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 506 KM 1.0 EDIFICIO SAN CRISTOBAL SUITE 213
PONCE PR
00780-2939
US

IV. Provider business mailing address

4002 CALLE EL ANAEZ
PONCE PR
00728-2024
US

V. Phone/Fax

Practice location:
  • Phone: 787-841-2228
  • Fax:
Mailing address:
  • Phone: 787-436-5128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23210
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: