MEDICARE: OFICINA DE OFTALMOLOGIA DR EMILIO A BAEZ RIVERA, CSP

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	207W00000X	Ophthalmology Physician	013195	PR

General Provider Information

NPI Number	:	1497776108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OFICINA DE OFTALMOLOGIA DR EMILIO A BAEZ RIVERA, CSP

Provider Business Mailing Address
First Line	:	PO BOX 4952
Second Line	:	PMB 580
City	:	CAGUAS
State	:	PR
Zip	:	00726-4952
Country	:	US
Telephone Number	:	787-258-2237
Fax Number	:	787-747-0964

Provider Business Practice Location Address
First Line	:	81 AVE LUIS MUNOZ MARIN STE 201
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00725-3883
Country	:	US
Telephone Number	:	787-258-2237
Fax Number	:	787-747-0964

Authorized Official
Title or Position	:	BILLING DIRECTOR
Name	:	MRS. DIANA V SANTANA
Credential	:
Telephone Number	:	787-314-2929

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	01/08/2024

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