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General NPI Number Information
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NPI Number | 1922790617
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Entity Type | Individual
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Provider Name | LADY C BAEZ PENA SA-C, P.A
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Gender | Female
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/12/2024
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Provider Practice Location Address
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Address Line | 3134 LANDINGS CIR APT 112
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City | ORLANDO
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State | FL
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Zip | 32824-0015
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Country | US
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Telephone | 850-556-5073
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Fax |
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Provider Business Mailing Address
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Address Line | 3134 LANDINGS CIR APT 112
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City | ORLANDO
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State | FL
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Zip | 32824-0015
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Country | US
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Telephone | 850-556-5073
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1663-P.A.
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 24-279
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License Number State | FL
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