MEDICARE: DR. LUIS G. BAEZ-TRINIDAD M.D.

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	2088P0231X	Pediatric Urology Physician	12603	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12603	OTHER	PR	MEDICAL LICENSE

General Provider Information

NPI Number	:	1366422834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS G. BAEZ-TRINIDAD M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6450
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-6450
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 SAN JORGE STREET
Second Line	:	SUITE 206
City	:	SANTURCE
State	:	PR
Zip	:	00912
Country	:	US
Telephone Number	:	787-727-1000
Fax Number	:

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	03/25/2008

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Directions to “ DR. LUIS G. BAEZ-TRINIDAD M.D.” Practice Location

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