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General NPI Number Information
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NPI Number | 1609967140
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Entity Type | Individual
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Provider Name | EDGARDO ISAAC BAEZ AYALA M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | CARR. 365 KM 0.8 BO. MACHUCHAL PLAZA ISABELLA LOCAL 2
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City | SABANA GRANDE
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State | PR
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Zip | 00637-0000
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Country | US
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Telephone | 939-717-9840
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Fax | 787-978-7196
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Provider Business Mailing Address
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Address Line | PRADERAS DE RIO FLORES 113
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City | SABANA GRANDE
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State | PUERTO RICO
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Zip | 00637
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Country | UM
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Telephone | 939-717-9840
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Fax | 787-978-7196
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 15719
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License Number State | PR
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Legacy Identifiers
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Identifier #1
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Identifier Code | 22869BA
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Identifier Type | OTHER
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Identifier State | PR
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Identifier Issuer | TRIPLE - S
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 22869BA
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Identifier Type | OTHER
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Identifier State | PR
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Identifier Issuer | TRIPLE - S
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