=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346281227
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | L. BAEZ CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2006
-----------------------------------------------------
Last Update Date | 07/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 NW 79TH AVE SUITE #176
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-591-4002
-----------------------------------------------------
Fax | 305-591-4001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 NW 79TH AVE SUITE #176
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-591-4002
-----------------------------------------------------
Fax | 305-591-4001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BAEZ LUIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-591-4002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------