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General NPI Number Information
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NPI Number | 1619145372
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Entity Type | Individual
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Provider Name | VIVENCIO PACLIBAR BAITAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 7487 S STATE ROAD 121
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City | MACCLENNY
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State | FL
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Zip | 32063-5451
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Country | US
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Telephone | 904-259-6211
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Fax | 904-259-7104
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Provider Business Mailing Address
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Address Line | 7487 S STATE ROAD 121
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City | MACCLENNY
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State | FL
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Zip | 32063-5451
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Country | US
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Telephone | 904-259-6211
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Fax | 904-259-7104
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | LL549
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License Number State | FL
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