Healthcare Provider Details

I. General information

NPI: 1518979772
Provider Name (Legal Business Name): MR. EDWIN FRANCISCO BAEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

1215 CALLE AZUCENA
TRUJILLO ALTO PR
00976-2725
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-641-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number681
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: