MEDICARE: SADE ADRIEL BAEZA PEREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach	B3497728BB	CA

General Provider Information

NPI Number	:	1225966591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SADE ADRIEL BAEZA PEREZ

Provider Business Mailing Address
First Line	:	1858 HAUSER CT APT 5
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-5663
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1858 HAUSER CT APT 5
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-5663
Country	:	US
Telephone Number	:	626-384-8830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2026
Last Update Date	:	05/08/2026

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Directions to “ SADE ADRIEL BAEZA PEREZ ” Practice Location

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