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General NPI Number Information
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NPI Number | 1760498950
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Entity Type | Individual
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Provider Name | PRISCILA BACO BAGUE MD
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Gender | Female
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 400 AVE DOMENECH LAS AMERICAS PROFESIONAL CENTER SUITE 202
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City | SAN JUAN
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State | PR
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Zip | 00918-3710
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Country | US
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Telephone | 787-250-1708
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Fax | 787-758-9200
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Provider Business Mailing Address
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Address Line | PO BOX 366257
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City | SAN JUAN
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State | PR
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Zip | 00936-6257
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Country | US
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Telephone | 787-250-1708
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Fax | 787-758-9200
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 9261
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License Number State | PR
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