MEDICARE: VILMARIE BAEZ

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	103TC0700X	Clinical Psychologist	PSY-1826	HI

General Provider Information

NPI Number	:	1346765336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VILMARIE BAEZ

Provider Business Mailing Address
First Line	:	1221 KAPIOLANI BLVD.
Second Line	:	PENTHOUSE 50 & 60
City	:	HONOLULU
State	:	HI
Zip	:	96814
Country	:	US
Telephone Number	:	808-260-9893
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 KAPIOLANI BLVD STE 1340
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96814-3806
Country	:	US
Telephone Number	:	808-225-2780
Fax Number	:

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

Provider Enumeration Date	:	08/10/2017
Last Update Date	:	02/19/2020

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Directions to “ VILMARIE BAEZ ” Practice Location

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