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General NPI Number Information
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NPI Number | 1225014434
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Entity Type | Individual
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Provider Name | EDGARD CRUZ BAEZ MD
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Gender | Male
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2669 AVE LAS AMERICAS URB CONSTANCIA
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City | PONCE
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State | PR
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Zip | 00717-2106
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Country | US
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Telephone | 787-259-1719
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 352
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City | MERCEDITA
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State | PR
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Zip | 00715-0352
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Country | US
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Telephone | 787-259-1719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 10957
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License Number State | PR
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